It is unknown how many endoscopic biopsy specimens are needed to diagnose celiac disease.
Dr Wilson Pais and colleagues from Canada determined the numbers of duodenal biopsy specimens needed to diagnose celiac disease in adults who underwent endoscopic gastroduodenoscopy.
|4 duodenal biopsy specimens should be taken for 100% confidence in diagnosis|
The team searched the pathology database for the keywords ‘consistent with celiac disease‘, ‘not consistent with celiac disease‘, ‘villous atrophy‘, and ‘intraepithelial lymphocytes' from 2001 to 2006.
The team determined the number of biopsy specimens graded for a modified Marsh classification, and charts were reviewed for diagnosis verification.
Celiac disease was confirmed if Marsh grade 3A was found, even on 1 biopsy specimen.
The research team's main outcome was the number of biopsy specimens needed to make the diagnosis of celiac disease .
The researchers identified 247 cases, of which 102 patients had biopsy specimen-confirmed celiac disease.
In 9 patients, celiac disease could not be confirmed on the basis of histology alone, but a clinical diagnosis was made on the basis of presentation and serology.
Celiac disease could be confirmed if only 2 biopsy specimens were obtained in 84 patients.
If 3 biopsy specimens were obtained, an additional 5 patients were diagnosed, and if at least 4 biopsy specimens were taken, the remainder of the patients were identified.
Celiac disease was ruled out in 145 patients.
In 142 patients, biopsy specimens were uniformly negative.
The research team identified 3 patients with Marsh grade 1 lesions but negative serology.
Dr Pais' team concluded, "Only 2 biopsy specimens will lead to a confirmed diagnosis of celiac disease in 90%, and a suspected diagnosis in all."
"For 100% confidence in diagnosis of celiac disease, 4 duodenal biopsy specimens should be taken."