ORIGINAL ARTICLES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2010 June;169(3):61-5

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English, Italian

Are endoscopic markers useful for the detection of adult coeliac disease?

Interlandi D., Puglisi M., Santonocito M. M., Calvagno G. S., Raciti C., Mondati E., Urso G.

Dipartimento di Medicina Interna e Patologie Sistemiche, Sezione di Medicina Interna e Medicina d’Urgenza, P.O. “S. Marta e Villermosa”, Università degli Studi di Catania, Catania

Aim. Adult coeliac disease (CD), in most cases, presents atypical and vague clinical manifestations. Among the clinical signs, the non specific dyspepsia is frequently observed. In the past few years endoscopic markers in the duodenum, highly predictive of histological alterations in patients with coeliac disease (CD), have been identified. The characteristic endoscopic pictures are: the thinning or disappearance of the Kerckring folds in distal duodenum; the “scalloping” of duodenal folds; the “mosaic” and the “micronodular” pattern of the mucosa, these last ones also sometimes present in the duodenal bulb. The checking of the validity of these endoscopic markers in the casual diagnosis in patients submitted to endoscopy for dyspeptic syndrome has been the aim of our study.
Materials and methods. We have considered 3160 consecutive endoscopies of the upper digestive tract performed, for the most varied causes, to the exclusion of the patients having serologic diagnosis of CD.
Results. Among 30 patients (1/105 – 24 females and 6 males) we have found characteristic endoscopic pictures. In 13 of these ones (43,3%) histology has confirmed the endoscopic suspicion of CD, because it satisfied the parameters of Marsh modified classification. The sierology, successively performed, has confirmed the diagnosis of CD in all the 13 patients (tTGA and EMA tests).
Discussion. The results of our study, with a predictive positive value of 43,3%, allow us to confirm the utility of the recognition of the characteristic endoscopic markers of coeliac disease (CD) in those subjects with a non suspected clinical history, extending the CD screening to all the patients that undergo endoscopy of the upper digestive tract for the most varied causes.