Celiac disease can manifest with nonspecific symptoms, including functional gastrointestinal disorders such as dyspepsia.
Dr Lecleire and colleagues from France evaluated the selection of dyspeptic patients for histological assessment.
The research team assessed the usefulness of duodenal endoscopic markers of villous atrophy for the selection of these patients.
The team performed esophagogastroduodenoscopy in dyspeptic patients considered to be at risk of having celiac disease, and in healthy controls.
At least 3 duodenal biopsies were performed for histological assessment of villous atrophy in all patients and controls.
The team looked for 4 duodenal endoscopic markers of celiac disease.
These markers included reduction in the number of folds, scalloping of folds, mosaic-pattern mucosa, and nodular mucosa.
| Additional endoscopic markers are valuable for diagnosis in patients with clinical symptoms|
The researchers enrolled a total of 175 people.
Of these, 75 patients had dyspepsia, 75 patients were at risk of having celiac disease, and 25 were healthy volunteers, or controls.
The team found that of the dyspeptic patients, 4 had endoscopic markers of celiac disease with no histologically confirmed villous atrophy.
A further patient without endoscopic markers was found to have Marsh type I villous atrophy.
Of the patients at risk of having celiac disease, 16 had at least one endoscopic marker and 10 of these were found to have histological villous atrophy.
The team observed that the sensitivity and specificity of the endoscopic markers were 100% and 91% respectively.
At-risk patients with 2 or more endoscopic markers all had histologically confirmed villous atrophy.
The researchers found neither endoscopic markers nor villous atrophy in any of the control patients.
Dr Lecleire's team concluded, “Additional endoscopic markers are valuable for diagnosis in patients with clinical symptoms suggestive of celiac disease.”
“In contrast, endoscopic markers of villous atrophy are not useful for selecting a subgroup of dyspeptic patients for screening for celiac disease by duodenal histological assessment.”
“These patients should be screened using other protocols.”