Endoscopic Features of Celiac Disease in Adults and Their Correlation with Age, Histological Damage, and Clinical Form of the Disease

Background and Study Aims: Although earlier studies have focused on endoscopic markers as predictors of celiac disease, there are still no certainties about the value of these markers. The aim of this study was to consider first, specific endoscopic features as predictors of specific histological damage; secondly, whether there is an association between the endoscopic features of celiac disease and the age of patients at the time of diagnosis; and thirdly, whether particular endoscopic features of celiac disease are associated with the clinical form of the disease.
Patients and Methods: We studied the endoscopic features of celiac disease in 144 consecutive adult patients (52 had the classical form of the disease, 64 the subclinical and 28 the silent form). The histopathological findings were expressed according to the Marsh classification.

Results: Slight/mild damage seen at endoscopy was associated with a Marsh II-IIIa grading (P < 0.005), while severe endoscopic damage was related to a Marsh IIIb-IIIc grading (P < 0.0005). Younger patients showed slighter damage at endoscopy (P < 0.001), while older patients showed more severe damage (P < 0.005). Finally, the classical form of celiac disease showed more severe damage at endoscopy, while the subclinical/silent forms of celiac disease showed slighter damage endoscopically (P < 0.001).
Conclusions: This study showed that the endoscopic appearance of the duodenum may be predictive of histological damage grading. Moreover, we showed that in young patients with subclinical/silent celiac disease there is a greater probability of finding slight/mild endoscopic abnormalities associated with slight/mild histological damage.

References

• 1 Working Group of the European Society of Paediatric Gastroenterology and Nutrition .Revised criteria for diagnosis of coeliac disease. Arch Dis Child 1990 65: 909-911
• 2 Trier J S. Celiac sprue.  N Engl J Med. 1991;  325 1709-1719
• 3 O’Mahoney S, Howdle P D, Losowsky M S. Review article: management of patients with non-responsive coeliac disease.  Aliment Pharmacol Ther. 1996;  10 671-678
• 4 Tursi A, Giorgetti G M, Brandimarte G. et al . Prevalence and clinical presentation of subclinical/silent coeliac disease in adults: an analysis on a 12-year observation.  Hepatogastroenterology. 2001;  39 462-464
• 5 Maurino E, Capizzano H, Niveloni S. et al . Value of endoscopic markers in celiac disease.  Dig Dis Sci. 1993;  38 2028-2033
• 6 Dickey W, Hughes D. Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy.  Am J Gastroenterol. 1999;  94 2182-2186
• 7 Bardella M T, Minoli G, Radaelli F. et al . Reevaluation of duodenal endoscopic markers in the diagnosis of celiac disease.  Gastrointest Endosc. 2000;  51 714-716
• 8 Meuwisse G H. Diagnostic criteria in coeliac disease.  Acta Pediatr. 1970;  59 461-463
• 9 Feighery C, Weir D G, Whelan A. et al . Diagnosis of gluten-sensitive enteropathy: is exclusive reliance on histology appropriate ?.  Eur J Gastroenterol Hepatol. 1998;  10 919-925
• 10 Marsh M N. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunologic approach to the spectrum of gluten sensitivity (celiac sprue).  Gastroenterology. 1992;  102 330-354
• 11 Brocchi E, Corazza G R, Caletti G. et al . Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease.  N Engl J Med. 1988;  319 741-744
• 12 Jabbari M, Wild G, Gorensky C A. et al . Scalloped valvulae conniventes: an endoscopic marker of celiac sprue.  Gastroenterology. 1988;  95 1518-1522
• 13 Corazza G R, Caletti G C, Lazzari R. et al . Scalloped duodenal folds in childhood celiac disease.  Gastrointest Endosc. 1993;  39 543-545
• 14 Brocchi E, Corazza G R, Brusco G. et al . Unsuspected celiac disease diagnosed by endoscopic visualization of duodenal bulb micronodules.  Gastrointest Endosc. 1996;  4 610-611
• 15 Vogelsang H, Hänel S, Steiner B, Oberhuber G. Diagnostic duodenal bulb biopsy in celiac disease.  Endoscopy. 2001;  33 336-340
• 16 Green P HR, Shane E, Rotterdam H. et al . Significance of unsuspected celiac disease detected at endoscopy.  Gastrointest Endosc. 2000;  51 60-65
• 17 Rokkas T, Karameris A. The usefulness of endoscopy in diagnosing celiac disease in Greece [letter].  Gastrointest Endosc. 2000;  52 451
• 18 McIntyre A S, Ng D PK, Smith J A. et al . The endoscopic appearance of duodenal folds is predictive of untreated adult celiac disease.  Gastrointest Endosc. 1992;  38 148-151
• 19 Ravelli A M, Tobanelli P, Minelli L. et al . Endoscopic features of celiac disease in children.  Gastrointest Endosc. 2001;  54 736-742
• 20 Dickey W, Hughes D. Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy.  Am J Gastroenterol. 2001;  96 2126-2128
• 21 Brocchi E, Tomassetti P, Misitano B. et al . Endoscopic markers in adult coeliac disease.  Dig Liver Dis. 2002;  34 177-182
• 22 Tursi A, Brandimarte G, Giorgetti G M. et al . Low prevalence of antigliadin and antiendomysium antibodies in subclinical/silent celiac disease.  Am J Gastroenterol. 2001;  96 1507-1510
• 23 Tursi A, Brandimarte G, Giorgetti G M. Sorbitol H₂-breath test versus anti-endomysium (EMA) antibodies for the diagnosis of subclinical/silent coeliac disease.  Scand J Gastroenterol. 2001;  36 1170-1172
• 24 Tursi A, Brandimarte G, Giorgetti G M. The use of non invasive diagnostic methods in clinical practice of coeliac disease.  Recenti Prog Med. 2001;  92 696-701