Routine Multiple Duodenal Biopsy during Endoscopy of Dyspeptic Patients Seems Unnecessary for Screening of Celiac Disease

Introduction. Celiac disease (CD) is a chronic and common cause of dyspepsia with a rising prevalence worldwide. This study is aimed at investigating the prevalence of CD in dyspeptic patients based on serology and biopsy, determining the associated factors, and assessing the necessity of regular duodenal biopsies from normal mucosa in diagnosis of CD among dyspeptic patients. Methods. This cross-sectional study was performed on 530 adult dyspeptic patients who underwent gastroduodenoscopy in Imam Reza hospital, Mashhad, during 2016-2018. Demographic characteristics, clinical data, and laboratory analyses were extracted from hospital records. CD was diagnosed based on intestinal biopsy and serum antitissue transglutaminase (anti-TTG) levels. Mucosal lesions were classified according to the modified Marsh classification. Data were analyzed in SPSS with P < 0.05 being considered significant. Results. Overall, 163 males (30.8%) and 367 females (69.2%) with an average age of 46.38 ± 15.54 years were studied. High anti-TTG levels were seen in 36 (6.8%) patients, and duodenal pathologies were seen in 23 (4.5%) patients. Fifteen (2.8%) were diagnosed with CD based on both serology and biopsy. Bloating was the most common type of dyspepsia in CD patients (7, 46.7%), followed by epigastric pain (6, 40%), and postprandial fullness (2, 13.3%). Two CD patients (13.3%) reported a positive family history for CD. Logistic regression model showed that iron deficiency anemia (IDA), anti-TTG level, and Helicobacter pylori infection were predictors of histological changes of CD, whereas IDA was the only independent predictor of CD in dyspeptic patients ( OR = 17.65 , 95 % CI = 1.53 ‐ 202.52 , and P = 0.021 ). Conclusion. CD is prevalent in dyspeptic patients, but routine biopsy from normal-appearing duodenal mucosa is not recommended for all patients. Serological studies, complete history, and careful endoscopic evaluation may provide better cost-effective clinical solutions to improve the diagnostic yield of celiac disease in dyspeptic patients.

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A survey of primary-care pediatricians regarding the management of Helicobacter pylori infection and celiac disease

Israel Journal of Health Policy Research ◽

10.1186/s13584-019-0357-x ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Amir Ben Tov ◽

Wasef Na’amnih ◽

Amna Bdair-Amsha ◽

Shlomi Cohen ◽

Judith Tzamir ◽

...

Keyword(s):

Primary Care ◽

Helicobacter Pylori ◽

Celiac Disease ◽

Educational Interventions ◽

Deficiency Anemia ◽

Pediatric Gastroenterology ◽

Cross Sectional ◽

First Choice ◽

H Pylori ◽

Primary Care Pediatricians

Abstract Background Adherence of primary-care pediatricians to guidelines in pediatric gastroenterology is essential to achieve optimal clinical outcomes. The study aim was to examine adherence of primary-care pediatricians to the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition guidelines on the management of Helicobacter pylori (H. pylori) infection and celiac disease. Methods We conducted a cross-sectional study during March–July 2017 using the survey platform of Maccabi Healthcare Services, the second largest state-mandated health organization in Israel. We sent the study questionnaire to a random sample of 300 pediatricians via electronic mails and to increase the response rate, we performed a telephone interview. Overall, 108 (36%) pediatricians provided completed questionnaires. Results Using professional guidelines for the management of H. pylori infection and celiac disease was reported by 34 and 37% of pediatricians, respectively. Referral to H. pylori testing was reported by 78 and 52% of pediatricians in children with suspected duodenal ulcer and unexplained iron deficiency anemia, respectively, with the stool antigen enzyme immunoassay being mostly (51%) used as the first choice diagnostic test. Most pediatricians reported prescription of triple therapy; proton pump inhibitors/clarithromycin/amoxicillin (59%) or metronidazole (21%). For celiac disease, overall adherence to all guidelines was high both for initial evaluation and for confirmation of diagnosis. Conclusions Adherence to the guidelines on management of H. pylori infection was low, while adherence to the guidelines on celiac disease management was high among primary-care pediatricians. Educational interventions are needed to improve H. pylori infection management among primary-care pediatricians.

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Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review

Nutrients ◽

10.3390/nu11112557 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2557 ◽

Cited By ~ 8

Author(s):

Martín-Masot ◽

Nestares ◽

Diaz-Castro ◽

López-Aliaga ◽

Alférez ◽

...

Keyword(s):

Celiac Disease ◽

Iron Deficiency ◽

Vitamin B12 ◽

Clinical Manifestations ◽

Vitamin B12 Deficiency ◽

Deficiency Anemia ◽

Intestinal Biopsy ◽

B12 Deficiency ◽

Endomysial Antibodies ◽

Inflammatory Bowel

Celiac disease (CD) is a multisystemic disorder with different clinical expressions, from malabsorption with diarrhea, anemia, and nutritional compromise to extraintestinal manifestations. Anemia might be the only clinical expression of the disease, and iron deficiency anemia is considered one of the most frequent extraintestinal clinical manifestations of CD. Therefore, CD should be suspected in the presence of anemia without a known etiology. Assessment of tissue anti-transglutaminase and anti-endomysial antibodies are indicated in these cases and, if positive, digestive endoscopy and intestinal biopsy should be performed. Anemia in CD has a multifactorial pathogenesis and, although it is frequently a consequence of iron deficiency, it can be caused by deficiencies of folate or vitamin B12, or by blood loss or by its association with inflammatory bowel disease (IBD) or other associated diseases. The association between CD and IBD should be considered during anemia treatment in patients with IBD, because the similarity of symptoms could delay the diagnosis. Vitamin B12 deficiency is common in CD and may be responsible for anemia and peripheral myeloneuropathy. Folate deficiency is a well-known cause of anemia in adults, but there is little information in children with CD; it is still unknown if anemia is a symptom of the most typical CD in adult patients either by predisposition due to the fact of age or because biochemical and clinical manifestations take longer to appear.

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Indications of Colonoscopy and Their Diagnostic Yield

10.53350/pjmhs21155995 ◽

2021 ◽

Vol 15 (5) ◽

pp. 995-998

Author(s):

M Naveed Anwar ◽

Humaira Achakzai ◽

Fahim ullah ◽

Wajeeha Qayyum ◽

Zaland Ahmed Yousfzai ◽

...

Keyword(s):

Computerized Tomography ◽

Diagnostic Yield ◽

Cross Sectional Study ◽

Deficiency Anemia ◽

Medical Institute ◽

Cross Sectional ◽

Common Indication ◽

Abnormal Growth ◽

Bowel Habits ◽

Internal Hemorrhoids

Aims: To look for common indications and gastrointestinal pathologies observed on colonoscopy and to assess its diagnostic yield with respect to different clinical indications. Study design: Observational cross-sectional study Place and duration of study: Department of Medicine, Rehman Medical Institute from 1st January 2018 to 31st March 2019 Methodology: Five hundred and seventy three patients referred for colonoscopy were included. The demographic profile, indication of colonoscopy and colonoscopy findings were noted. Results: There were 231 (40.3%) males and 342 (59.7%) females with mean age 42.32±17.51 years. Bleed per rectum was most common indication noted in 284 (49.6%) followed by altered bowel habits 125 (21.8%) cases. Two hundred and fifty two (44%) colonoscopies were normal. One hundred and seventy three (30.2%) revealed significant lesions and 148 (25.8%) lesions were insignificant. Internal hemorrhoids were observed in 130 (22.7%) followed by colitis in 54 (9.4%). Abnormal computerized tomography abdomen revealed significant lesions in 62.2% of patients. Chronic diarrhea followed by constipation, altered bowel habits and iron deficiency anemia (IDA) showed 34.5%, 25.7%, 17.6% and <10% significant lesions respectively. Conclusion: Rectal bleed was the most common indication followed by altered bowel habits. Most common colonoscopy findings were hemorrhoids followed by colitis and abnormal growth. Abnormal computerized tomography abdomen gave the best diagnostic yield for colonoscopy. Keywords: Colonoscopy, Indications, Diagnostic yield

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CELIAC DISEASE

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.01.1414 ◽

2015 ◽

Vol 22 (01) ◽

pp. 072-075

Author(s):

Sana Zulfiqar ◽

Amin Fahim ◽

Aneela Qureshi ◽

Sadia Adnan ◽

Shomail Saeed Siddiqui ◽

...

Keyword(s):

Celiac Disease ◽

Histopathological Examination ◽

Duodenal Mucosa ◽

Cross Sectional Study ◽

University Hospital ◽

P Value ◽

Cross Sectional ◽

Marsh Type ◽

History Of ◽

And Gender

Objective: To find out the Modified Marsh type of celiac disease (CD)patients on histopathological examination of duodenal (D2) biopsies and to correlate it withtissue transglutaminase IgA levels. Study Design: Cross sectional study. Place of Study:Histopathology laboratory (Department of Pathology), Isra University Hospital and AsianInstitute of Medical Sciences (AIMS), Hyderabad. Duration of Study: July 2013 to December2013. Materials and Methods: 96 patients with a history of malabsorption or atypical symptomswith clinical suspicion of CD were subjected to endoscopy. Endoscopic duodenal (D2) biopsieswere taken regardless of age and gender. D2 biopsies were processed for histopathologicalexamination under light microscopy. Results: Out of 96 patients, 45 (46.9%) patients hadmoderate type of lamina propria inflammation along with highly significant p-value (0.0001).CDtype 3a was observed in 34 patients (35.4%). In this study the comparison of serological level oftissue Transglutaminase IgA (tTGA) and histological severity revealed significant correlation. AllModified Marsh types of CD with tTGA level seen in our study were highly significant (p-value0.001). Conclusion: In this study strong correlation was observed between the serologicaltTGA level and histological findings by Modified Marsh classification along with lamina propriainflammation of duodenal mucosa in CD patients.

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The association between eating rate and functional dyspepsia in Iranian adults

10.21203/rs.2.23971/v1 ◽

2020 ◽

Author(s):

Parvane Saneei ◽

Ammar Hassanzadeh Keshteli ◽

Hamid Rasad ◽

Hamed Daghaghzadeh ◽

Awat Feizi ◽

...

Keyword(s):

Functional Dyspepsia ◽

Epigastric Pain ◽

Large Population ◽

Cross Sectional Study ◽

Dietary Habit ◽

Eating Rate ◽

Cross Sectional ◽

Postprandial Fullness ◽

Gastrointestinal Health ◽

Early Satiation

Abstract Objective: This study aimed to investigate the association between eating rate and functional dyspepsia (FD) in a large population of Iranian adults.Methods: In this cross-sectional study, we assessed eating rate of 4763 Iranian adults using a dietary habit questionnaire. We used a modified validated version of the Rome III questionnaire to assess gastrointestinal health. FD was defined as having one or more of the following characteristics: bothersome postprandial fullness, early satiation and/or epigastric pain or epigastric burning. Needed information on meal frequency, meal regularity, intra-meal fluid drinking as well as on other potential confounders was obtained by using a pre-tested questionnaire.Results: Functional dyspepsia was prevalent in 15.2% (n=703) of the studied population. Lunch and total eating rate was associated with greater odds of having FD(OR: 1.37; 95% CI: 1.04-1.8) and (OR: 1.45; 95% CI: 1-2.11), respectively). However, this relationship weakened after adjusting for confounding factors. No significant relationship was found between dinner eating rate and FD in both crude and adjusted models (OR: 1.23; 95% CI: 0.83-1.51). There was no significant relation between lunch, dinner or total eating rate and risk of postprandial fullness, early satiation or epigastric pain either in crude or adjusted models. Eating rate was not related to severity or frequency of FD components.Conclusions: Fast eating was associated with greater odds of FD. However, there was no association between fast eating with postprandial fullness and epigastria pain. Further studies, particularly prospective ones, are required to confirm these relations.

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Diagnostic Yield of Endoscopic Procedures in Children: Experience of a Portuguese Center

GE Portuguese Journal of Gastroenterology ◽

10.1159/000507207 ◽

2020 ◽

Vol 27 (6) ◽

pp. 404-409

Author(s):

Sónia Silva ◽

Cláudia Silva ◽

Maria do Céu Espinheira ◽

Isabel Pinto Pais ◽

Eunice Trindade ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Celiac Disease ◽

Bowel Disease ◽

Foreign Bodies ◽

Epigastric Pain ◽

Diagnostic Yield ◽

Quality Criteria ◽

Endoscopic Procedures ◽

Endoscopic Techniques ◽

Inflammatory Bowel

Background: Over the last decades, the use of gastrointestinal (GI) endoscopic procedures has been increased in children worldwide, allowing the early diagnosis and therapeutic intervention in multiple GI diseases. Aims and Methods: In order to evaluate the appropriateness and the diagnostic yield of initial GI endoscopic techniques in children in a Portuguese tertiary hospital, we performed a retrospective cohort study during a 12-month period. Results:A total of 308 procedures were performed in 276 patients; the median age was 11 years and 50.4% were males. Esophago-gastro-duodenoscopy (EGD) corresponded to 81.8% of the procedures and ileo-colonoscopy (IC) to the remaining; 11.6% of the patients underwent both EGD and IC. Overall, 51.3% of the exams showed abnormal macroscopic findings, and 69.6% showed histopathological signs of disease, with IC showing significantly more positive results than EGD (p < 0.05). Considering the different indications independently, abnormal serology for celiac disease, suspected ingestion of foreign bodies, suspected inflammatory bowel disease, and food impaction were frequent in our population; and in the majority of the cases, the suspected diagnosis was confirmed: celiac disease, ingestion of foreign bodies, inflammatory bowel disease, and eosinophilic esophagitis, respectively. On the other hand, despite the high frequency of epigastric pain in this population, only nearly one-third of the patients showed abnormal histological findings. The final diagnosis was established in 63% of the patients, and 39.1% initiated the new treatment. Discussion:Our results emphasize the importance of endoscopic procedures, especially IC, in the diagnosis of GI diseases in pediatric patients, as well as the careful choice of the endoscopic techniques in those with less specific symptoms, as chronic abdominal pain. In this particular situation, given the proportion of cases that may be due to functional disease, good characterization of the clinical context is needed, and endoscopy should be reserved for a second-line approach. Conclusion: It is important to monitor and examine the endoscopic techniques as an index of quality criteria for clinical practice.

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1172 Low Diagnostic Yield of Dudodenal Biopsy of Celiac Disease in Patients With Iron Deficiency Anemia and Malabsorption Symptoms

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000594216.95080.6e ◽

2019 ◽

Vol 114 (1) ◽

pp. S654-S656

Author(s):

Alvin Guyun Kwon ◽

Heesoo Yoo ◽

Myungwoo Nam ◽

Nghia Nguyen ◽

Maria Barsky ◽

...

Keyword(s):

Celiac Disease ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Diagnostic Yield ◽

Deficiency Anemia

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Diagnostic Yield of Routine Duodenal Biopsies in Iron Deficiency Anemia for Celiac Disease Diagnosis

ISRN Endoscopy ◽

10.5402/2013/769519 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Houria Chellat ◽

Mouna Salihoun ◽

Nawal Kabbaj ◽

Leila Amrani ◽

Ilham Serraj ◽

...

Keyword(s):

Celiac Disease ◽

Small Bowel ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Diagnostic Yield ◽

Disease Diagnosis ◽

Deficiency Anemia ◽

Duodenal Lesions ◽

Obscure Origin ◽

Duodenal Biopsies

Background. Iron deficiency anemia (IDA) is a recognised feature of celiac disease (CD) in adults and can be its only presentation. Aim. To define the prevalence of CD in Moroccan adult patients with IDA of obscure origin and to determine the yield of small bowel biopsy performed during routine endoscopy. Methods. 437 patients with IDA of obscure origin were included. 4 endoscopic mucosal biopsies were taken from the second part of duodenum and 2 biopsies from antrum and fundus, respectively. Endoscopic aspect and severity of anemia were correlated with histological diagnoses using coefficient Kappa. Results. 29 out of 437 patients (6.63%) had CD. Endoscopic aspect was normal in 66%, a mosaic pattern of mucosa in 17%, and scalloping of the small bowel folds in 17%. 12 patients had Marsh III, 8 had Marsh II, 6 had Marsh I, and 3 had Marsh IV lesions. There was no correlation between degree of anemia, endoscopic aspect, and severity of duodenal lesions . Conclusion. Routine duodenal biopsy gives an additional 6.63% diagnostic benefit of CD and should be indicated in all patients with IDA. The finding of normal endoscopic appearance of mucosa should not preclude duodenal biopsies.

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PREVALENCE OF CELIAC DISEASE IN CHILDREN WITH EPILEPSY

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032013000400010 ◽

2013 ◽

Vol 50 (4) ◽

pp. 290-296 ◽

Cited By ~ 9

Author(s):

Camilo VIEIRA ◽

Izabele JATOBÁ ◽

Marília MATOS ◽

Daniel DINIZ-SANTOS ◽

Luciana R. SILVA

Keyword(s):

Celiac Disease ◽

Pediatric Patients ◽

Villous Atrophy ◽

Duodenal Mucosa ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Symptomatic Epilepsy ◽

Endomysium Antibodies ◽

Serial Measurements

ContextNeurological symptoms have been well-documented in patients with celiac disease, nevertheless, the presumption of a greater prevalence of epilepsy in celiac patients remains controversial.ObjectivesTo determine the frequency of celiac disease in children and adolescents with idiopathic or cryptogenic epilepsy.MethodsA cross-sectional study. One hundred pediatric patients with non-symptomatic epilepsy were followed-up at two public pediatric neurology clinics in Salvador, Bahia, Brazil. Screening for celiac disease was performed by serial measurements of IgA anti-transglutaminase and IgA anti-endomysium antibodies, followed by bowel biopsy in positive cases. HLA DQ02 and DQ08 were investigated in seropositive individuals, assessing the type of seizures, the number of antiepileptic drugs used and the presence gastrointestinal symptoms.ResultsThree (3.0%) patients tested anti-tTG-positive, two with normal duodenal mucosa (Marsh 0) and one with intraepithelial infiltrate (Marsh I). No villous atrophy of the duodenal mucosa (Marsh III) celiac disease was found. Two patients tested positive for HLA DQ02; none were DQ08 positive.ConclusionThe present study failed to prove the association between celiac disease and epilepsy.

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Celiac Disease in Children with Chronic Diarrhoea: A Cross-sectional Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46825.14397 ◽

2021 ◽

Author(s):

YM Bhavika ◽

DG Prasanna Kumar ◽

HN Harish

Keyword(s):

Celiac Disease ◽

Tissue Transglutaminase ◽

Tertiary Care ◽

Cross Sectional Study ◽

Intestinal Biopsy ◽

Chronic Diarrhoea ◽

Sectional Study ◽

Tertiary Care Centre ◽

Serological Tests ◽

Cross Sectional

Introduction: Celiac disease is a chronic gastrointestinal disorder, very often underdiagnosed due to lack of awareness among the general practitioners. Aim: To study the prevalence of celiac disease among children with chronic diarrhoea. Materials and Methods: A cross-sectional study was conducted in which, 890 children between the age group of 1-18 years with history of chronic diarrhoea (loose stools or increased frequency for more than two weeks) were enrolled, between November 2015 and January 2018 in a tertiary care centre in India. The children were screened with serological tests for celiac disease and among those who were tested positive; the diagnosis was confirmed by intestinal biopsy. Results: Of the 890 patients with chronic diarrhoea, 252 (28.3%) were tested positive for anti-tissue Transglutaminase (tTG) antibodies with levels more than 10 times the upper normal limit. Among the 252 patients with positive serology, 144 patientshad intestinal biopsy findings suggestive of celiac disease (Marsh stage 3b and 3c) while the rest had normal or mild (marsh grade 1, 2 and 3a) histological changes. Conclusion: Celiac disease is one of the most important causes of chronic diarrhoea and hence should be actively looked for in children presenting with chronic diarrhoea.

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