Revista Espanola de Enfermedades Digestivas (Jun 2013)

Endoscopic and histological pitfalls in the diagnosis of celiac disease: a multicentre study assessing the current practice

  • Mohammad Rostami-Nejad,
  • Vincenzo Villanacci,
  • Sabine Hogg-Kollars,
  • Umberto Volta,
  • Stefania Manenti,
  • Mohammad Reza-Zali,
  • Giacomo Caio,
  • Paolo Giovenali,
  • Ausrine Barakauskiene,
  • Edita Kazenaite,
  • Gabriel Becheanu,
  • Mircea Diculescu,
  • Salvatore Pellegrino,
  • Giuseppe Magazzù,
  • Giovanni Casella,
  • Camillo Di-Bella,
  • Nicola Decarli,
  • Mauro Biancalani,
  • Gabrio Bassotti,
  • Kamran Rostami

DOI
https://doi.org/10.4321/s1130-01082013000600003
Journal volume & issue
Vol. 105, no. 6
pp. 326 – 333

Abstract

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Background and aims: the diagnosis of celiac disease requires small bowel biopsies to identify the characteristic mucosal changes. The current biopsy practice among endoscopists for celiac disease is in most part unknown. The aim of this study was to compare the different diagnostic policies in various centers in their current practice. Method: information from a total of 931 confirmed celiac disease patients was retrospectively obtained retrospectively from nine centers in European and Middle Eastern countries. The number of small-bowel biopsies obtained from the duodenal bulb and the second part of the duodenum was compared among different centers. Results: the most frequent stage of mucosal changes amongst Iranian subjects was Marsh IIIa whereas in the rest of the study population was Marsh IIIc. Marsh I and Marsh II were more prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher in pediatric ages between 1 and 15 (P < 0.05). The most common number of biopsy specimens obtained from Romanian subjects was 1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). For majority of cases, anemia was the most prevalent symptom (18.7%) followed by malabsorption (10.5%), diarrhea (9.3%) and dyspepsia (8.2%), respectively. Conclusions: despite the evidence-based recommendations, this study revealed a poor compliance with major guidelines on diagnosis of celiac disease. We emphasize that taking adequate number of duodenal biopsies should be implemented for an accurate diagnosis and also for the exclusion of celiac disease.

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