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Endoscopic markers for celiac disease

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 546–551 (2006)Cite this article

Abstract

Celiac disease is common and can present with nonspecific upper gastrointestinal symptoms. Patients may therefore undergo esophagogastroduodenoscopy as their initial investigation. Markers of villous atrophy, which can be seen in the duodenum during endoscopy, are well described. They have limited sensitivity for patients with mild enteropathy and duodenal biopsies should be performed if there is strong suspicion of celiac disease irrespective of endoscopic appearance. Endoscopic markers do, however, allow the selection of patients with nonspecific symptoms for duodenal biopsy, and these markers should, therefore, be looked for routinely during esophagogastroduodenoscopy.

Key Points

  • Celiac disease is common and can present with upper gastrointestinal symptoms rather than malabsorption

  • Esophagogastroduodenoscopy might be the first investigation ordered in patients with celiac disease

  • There are well-defined markers of villous atrophy in the duodenum that should be routinely looked for during endoscopy

  • The absence of endoscopic markers should not preclude biopsy if celiac disease is strongly suspected, because the markers lack sensitivity, particularly for mild enteropathy

  • Endoscopic markers are useful in the selection of patients who have nonspecific upper gastrointestinal symptoms for biopsy

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Figure 1: Endoscopic markers of villous atrophy visible in the duodenum at esophagogastroduodenoscopy.
Figure 2: Abnormalities seen in patients with celiac disease on wireless capsule endoscopy.

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References

  1. Fasano A et al. (2003) Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 163: 286–292

    Article  Google Scholar 

  2. United European Gastroenterology (2001) When is a coeliac a coeliac? Report of a working group of the United European Gastroenterology Week in Amsterdam, 2001. Eur J Gastroenterol Hepatol 13: 1123–1128

  3. Saverymuttu SH et al. (1991) Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy. Postgrad Med J 67: 47–49

    Article  CAS  Google Scholar 

  4. Marsh MN (1992) Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue'). Gastroenterology 102: 330–354

    Article  CAS  Google Scholar 

  5. Oberhuber G et al. (1999) The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 11: 1185–1194

    Article  CAS  Google Scholar 

  6. Dickey W and McMillan SA (2005) Increasing numbers at a specialist coeliac clinic: contribution of serological testing in primary care. Dig Liver Dis 37: 928–933

    Article  CAS  Google Scholar 

  7. Dickey W and Bodkin S (1998) Prospective study of body mass index in coeliac disease. Br Med J 317: 1290

    Article  CAS  Google Scholar 

  8. Fasano A and Catassi C (2001) Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology 120: 636–651

    Article  CAS  Google Scholar 

  9. Ciacci C et al. (1995) Gender and clinical presentation in adult celiac disease. Scand J Gastroenterol 30: 1077–1081

    Article  CAS  Google Scholar 

  10. Usai P et al. (1995) Oesophageal motility in adult coeliac disease. Neurogastroenterol Motil 7: 239–244

    Article  CAS  Google Scholar 

  11. Cuomo A et al. (2003) Reflux oesophagitis in adult coeliac disease: beneficial effect of a gluten free diet. Gut 52: 514–517

    Article  CAS  Google Scholar 

  12. Maieron R et al. (2005) Celiac disease and intestinal metaplasia of the esophagus (Barrett's esophagus). Dig Dis Sci 50: 126–129

    Article  Google Scholar 

  13. Bassotti G et al. (1994) Abnormal gastrointestinal motility in patients with celiac sprue. Dig Dis Sci 39: 1947–1954

    Article  CAS  Google Scholar 

  14. Iovino P et al. (1998) Esophageal impairment in adult celiac disease with steatorrhea. Am J Gastroenterol 93: 1243–1249

    Article  CAS  Google Scholar 

  15. Usai P et al. (1997) Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. Eur J Clin Invest 27: 1009–1015

    Article  CAS  Google Scholar 

  16. Bardella et al. (2000) Gastric emptying and plama neurotensin levels in untreated celiac patients. Scan J Gastroenterol 35: 269–273

    Article  CAS  Google Scholar 

  17. Kilander AF et al. (1984) Plasma enteroglucagon related to malabsorption in coeliac disease. Gut 25: 629–635

    Article  CAS  Google Scholar 

  18. Wahab PJ et al. (2001) Basal and fat-stimulated plasma peptide YY levels in celiac disease. Dig Dis Sci 46: 2504–2509

    Article  CAS  Google Scholar 

  19. Giorgetti GM et al. (2004) Assessment of autonomic function in untreated adult coeliac disease. World J Gastroenterol 10: 2715–2718

    Article  Google Scholar 

  20. Dickey W and Hughes DF (2004) Erosions of the second part of duodenum in patients with villous atrophy. Gastrointest Endosc 59: 116–118

    Article  Google Scholar 

  21. Brocchi E et al. (2002) Endoscopic markers in adult coeliac disease. Dig Liver Dis 34: 177–182

    Article  CAS  Google Scholar 

  22. Brocchi E et al. (1998) Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease. N Engl J Med 319: 741–744

    Article  Google Scholar 

  23. McIntyre AS et al. (1992) The endoscopic appearance of duodenal folds is predictive of untreated adult celiac disease. Gastrointest Endosc 38: 148–151

    Article  CAS  Google Scholar 

  24. Maurino E et al. (1993) Value of endoscopic markers in celiac disease. Dig Dis Sci 38: 2028–2033

    Article  CAS  Google Scholar 

  25. Dickey W and Hughes DF (2001) Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy. Am J Gastroenterol 96: 2126–2128

    CAS  Google Scholar 

  26. Oxentenko AS et al. (2002) The insensitivity of endoscopic markers in celiac disease. Gastrointest Endosc 97: 933–938

    Google Scholar 

  27. Lecleire S et al. (2006) Endoscopic markers of villous atrophy are not useful for the detection of celiac disease in patients with dyspeptic symptoms. Endoscopy 38: 696–701

    Article  CAS  Google Scholar 

  28. Culliford A et al. (2004) Scalloping of duodenal mucosa in Crohn's disease. Inflamm Bowel Dis 10: 270–273

    Article  Google Scholar 

  29. Shah VH et al. (2000) All that scallops is not celiac disease. Gastrointest Endosc 51: 717–720

    Article  CAS  Google Scholar 

  30. Luzi G et al. (2003) Duodenal pathology and clinical–immunological implications in common variable immunodeficiency patients Am J Gastroenterol 98: 118–121

    Article  Google Scholar 

  31. Dickey W (2002) Low serum B12 is common in coeliac disease and is not due to autoimmune gastritis. Eur J Gastroenterol Hepatol 14: 425–427

    Article  CAS  Google Scholar 

  32. Mahmud FH et al. (2005) Celiac disease in type 1 diabetes mellitus in a North American community: prevalence, serologic screening, and clinical features. Mayo Clin Proc 80: 1429–1434

    Article  Google Scholar 

  33. Ch'ng CL et al. (2005) Prospective screening for coeliac disease in patients with Graves' hyperthyroidism using anti-gliadin and tissue transglutaminase antibodies. Clin Endocrinol 62: 303–306

    Article  Google Scholar 

  34. Green PHR and Murray J (2003) Routine duodenal biopsies to exclude celiac disease? Gastrointest Endosc 58: 92–95

    Article  Google Scholar 

  35. Dickey W and Hughes D (1999) Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy. Am J Gastroenterol 94: 2182–2186

    Article  CAS  Google Scholar 

  36. Bardella MT et al. (2000) Reevaluation of duodenal endoscopic markers in the diagnosis of celiac disease. Gastrointest Endosc 51: 714–716

    Article  CAS  Google Scholar 

  37. Collin P et al. (2002) The hunt for coeliac disease in primary care. Q J Med 95: 75–77

    Article  CAS  Google Scholar 

  38. Dickey W (1998) Diagnosis of coeliac disease at open-access endoscopy. Scand J Gastroenterol 33: 612–615

    Article  CAS  Google Scholar 

  39. Vjero K et al. (2003) Defining a proper setting for endoscopy in coeliac disease. Eur J Gastroentero Hepatol 15: 675–678

    Article  Google Scholar 

  40. Stevens FM and McCarthy CF (1976) The endoscopic demonstration of coeliac disease. Endoscopy 8: 177–180

    Article  CAS  Google Scholar 

  41. Niveloni S et al. (1998) Usefulness of videoduodenoscopy and vital dye staining as indicators of mucosal atrophy of celiac disease: assessment of interobserver agreement. Gastrointest Endosc 47: 223–229

    Article  CAS  Google Scholar 

  42. Siegel LM et al. (1997) Combined magnification endoscopy with chromoendoscopy in the evaluation of patients with suspected malabsorption. Gastrointest Endosc 46: 226–230

    Article  CAS  Google Scholar 

  43. Cammarota G et al. (2004) Reliability of the “immersion technique” during routine upper endoscopy for detection of abnormalities of duodenal villi in patients with dyspepsia. Gastrointest Endosc 60: 223–228

    Article  Google Scholar 

  44. Cammarota G et al. (2004) Direct visualization of intestinal villi by high-resolution magnifying upper endoscopy: a validation study. Gastrointest Endosc 60: 732–738

    Article  Google Scholar 

  45. Badreldin R et al. (2005) How good is zoom endoscopy for assessment of villous atrophy in coeliac disease? Endoscopy 37: 994–998

    Article  CAS  Google Scholar 

  46. Cammarota G et al. (2006) High accuracy and cost-effectiveness of a biopsy-avoiding endoscopic approach in diagnosing coeliac disease. Aliment Pharm Ther 23: 61–69

    Article  CAS  Google Scholar 

  47. Cellier C et al. (2005) ICCE consensus for celiac disease. Endoscopy 37: 1055–1059

    Article  CAS  Google Scholar 

  48. Culliford A et al. (2005) The value of wireless capsule endoscopy in patients with complicated celiac disease. Gastrointest Endosc 62: 55–61

    Article  Google Scholar 

  49. Pertroniene E et al. (2005) Given capsule endoscopy in celiac disease: evaluation of diagnostic atrophy and interobserver agreement. Am J Gastroenterol 100: 685–694

    Article  Google Scholar 

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Authors and Affiliations

  1. Altnagelvin Hospital,

    William Dickey

  2. Life and Health Sciences at the University of Ulster, Londonderry, Northern Ireland

    William Dickey

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Correspondence to William Dickey.

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Dickey, W. Endoscopic markers for celiac disease. Nat Rev Gastroenterol Hepatol 3, 546–551 (2006). https://doi.org/10.1038/ncpgasthep0601

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  • DOI: https://doi.org/10.1038/ncpgasthep0601

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