Performing routine duodenal biopsies to diagnose Celiac Disease: is there any value?

Le résumé fourni par la source

Aims Duodenal biopsies are routinely performed on all patients exhibiting symptoms suggestive of Celiac Disease (CD). The aim of our study is to evaluate the diagnostic yield of systematic duodenal biopsies in patients showing clinical manifestations suggestive of CD. Methods This is a single-center study conducted over a period of 2 years, involving patients who underwent upper digestive endoscopy with duodenal biopsies. Clinical presentations were classified as either high-risk or low-risk for celiac disease. High-risk presentations included iron-deficiency anemia and diarrhea. Other indications were categorized as low-risk (dyspepsia, ulcer-type epigastric pain, and atypical epigastric pain). Results We included 190 predominantly female patients (70%). The mean age was 41 years [10-83 years]. The primary indications for endoscopy were iron-deficiency anemia in 59.5% of cases and chronic diarrhea in 24.2% of cases. Endoscopically, 55 patients (29%) showed features suggestive of celiac disease: reduced duodenal fold height in 46 patients (24.2%), nodular mucosa in 6 patients, and a mosaic appearance in 3 patients. Histologically, among the 126 patients with normal duodenal mucosa, 5 patients (3%) presented histological abnormalities: villous atrophy in 2 patients and focal elevation of intraepithelial lymphocytes in 3 patients. Among the 46 patients with reduced duodenal fold height on endoscopy, only 41% had histological abnormalities: villous atrophy (N=12) and elevated intraepithelial lymphocytes (N=7). Among the 6 patients with nodular appearance, 2 patients had histological abnormalities: partial villous atrophy and active duodenitis without specific signs. All patients with a mosaic appearance had a histological alteration: polymorphic inflammatory infiltration suggestive of nonspecific duodenitis. The diagnosis of celiac disease was established in 12 patients (6.3%), of whom two had a normal endoscopic appearance. No patient with low-risk symptoms and a normal endoscopic appearance was diagnosed with celiac disease. In multivariate analysis, only reduced duodenal fold height on endoscopy was correlated with the diagnosis of celiac disease (CI=95%, p=0.0001). Conclusions Our study supports recommendations for systematic duodenal biopsies in patients with high-risk clinical or biological presentations for celiac disease. We also suggest that biopsies should be performed in patients with low-risk symptoms who exhibit endoscopic markers of CD. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.