Celiac Disease and Other Causes of Duodenitis

Context.— Patients who receive an upper gastrointestinal endoscopic examination frequently have biopsies taken from the duodenum. Accurate interpretation of duodenal biopsies is essential for patient care. Celiac disease is a common clinical concern, but pathologists need to be aware of other conditions of the duodenum that mimic celiac disease. Objective.— To review the normal histologic features of duodenal mucosa and describe the clinical and histologic findings in celiac disease and its mimics, listing the differentiating features of biopsies with villous atrophy and epithelial lymphocytosis. Data Sources.— The study comprises a literature review of pertinent publications as of November 30, 2016. Conclusions.— Celiac disease is a common cause of abnormal duodenal histology. However, many of the histologic features found in the duodenal biopsy of patients with celiac disease are also present in other conditions that affect the small bowel. Diagnostic precision may be enhanced by obtaining a careful patient history and by ancillary laboratory testing, particularly for the presence of antitissue transglutaminase antibodies.

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Histopathologic Manifestations of Crohn Disease in Duodenal Endoscopy Biopsy: The Value of Different Patterns of Involvement of Brunner Glands

International Journal of Surgical Pathology ◽

10.1177/1066896921998438 ◽

2021 ◽

pp. 106689692199843

Author(s):

Badr AbdullGaffar ◽

Hoda Quraishi

Keyword(s):

Crohn Disease ◽

Duodenal Biopsy ◽

Inflammatory Lesions ◽

Specific Sign ◽

Mucosal Erosion ◽

Transmural Inflammation ◽

Active Inflammation ◽

Upper Gastrointestinal ◽

Brunner Glands ◽

Duodenal Biopsies

Crohn disease (CD) not uncommonly involves the upper gastrointestinal tract, usually gastric antrum and proximal duodenum. The most consistent histopathologic manifestations of CD in duodenal biopsies are mucosal erosion, focal active inflammation, and granulomas. Since CD is a transmural inflammation and since duodenal biopsy may include submucosal Brunner glands, we aimed to find if CD has any specific histopathologic manifestations in Brunner gland lobules and their ducts compared to other duodenal inflammatory lesions. We carried out a retrospective review study over 6 years retrieving duodenal biopsy specimens in CD patients. We compared duodenal specimens involved by CD with other inflammatory lesions, for example, ulcerative colitis (UC), Helicobacter pylori-associated gastritis, non-Helicobacter gastritis, Celiac sprue, infections, and drugs. We found focal active duodenitis and erosion in CD cases and non-CD cases. Granulomas were found in CD cases. Five cases of CD showed inflammatory and degenerative changes of Brunner glands. Focal patchy active inflammation of only portion of submucosal Brunner gland lobule, mucosal Brunner glands, and their ducts was solely found in CD cases. This focally enhanced inflammation of Brunner glands was not found in other lesions. Whether this phenomenon of focal active “lobulitis” and “ductitis” is a specific sign of duodenal CD compared to UC and other inflammatory lesions warrants verification. We encourage endoscopists to include submucosal Brunner lobules in their duodenal biopsy samples and pathologists to look for these patterns of involvement particularly in patients suspected of CD.

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Descriptive Study of the Different Tools Used to Evaluate the Adherence to a Gluten-Free Diet in Celiac Disease Patients

Nutrients ◽

10.3390/nu10111777 ◽

2018 ◽

Vol 10 (11) ◽

pp. 1777 ◽

Cited By ~ 5

Author(s):

Luis Rodrigo ◽

Isabel Pérez-Martinez ◽

Eugenia Lauret-Braña ◽

Adolfo Suárez-González

Keyword(s):

Celiac Disease ◽

Multidisciplinary Approach ◽

Descriptive Study ◽

Duodenal Mucosa ◽

Gluten Free Diet ◽

Gluten Free ◽

Autoimmune Process ◽

Duodenal Biopsies

Celiac disease (CD) is a genetically conditioned autoimmune process that appears in susceptible people. It can affect people of any age, and slightly predominates in females. It has a fairly homogenous global distribution, with an average prevalence of 1–2%, the frequency having increased in recent decades. The only effective treatment is a strict and permanent gluten-free diet (GFD), although the level of compliance is poor, at about 50% of cases. To monitor the effectiveness of the GFD, several procedures involving various approaches are employed: (a) Periodic visits by expert Nutritionists; (b) Clinical follow-up; (c) Serological time controls of specific antibodies; (d) Serial endoscopies with collection of duodenal biopsies; (e) Use of structured questionnaires; and (f) Determination of gluten peptides derived from gluten in faeces and/or urine. All of these procedures are useful when applied, alone or in combination, depending on the cases. Some patients will only need to consult to their doctors, while others will require a multidisciplinary approach to assess their compliance with the GFD. In children, normalization of duodenal mucosa was achieved in 95% of cases within two years, while it is more delayed in adults, whose mucosa take longer time (3–5 years) to heal completely.

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The role of serological tests and biopsy in the diagnosis of celiac disease: retrospective review of 1137 duodenal biopsies

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205827 ◽

2020 ◽

Vol 9 (1) ◽

pp. 27

Author(s):

Feridun Gurlek ◽

Eyyup Tasdemir ◽

Taskın Erkinuresin

Keyword(s):

Celiac Disease ◽

Serological Test ◽

Young Female ◽

Duodenal Biopsy ◽

Gluten Sensitivity ◽

Biopsy Result ◽

Serological Tests ◽

Number Of Patients ◽

Significant Difference ◽

Duodenal Biopsies

Background: The aim of this study is to evaluate gluten sensitivity and/or celiac disease (CD) on the basis of serological tests and duodenal biopsy and to draw attention to the prevalence in the population and the correlation between serological tests and biopsy results.Methods: Patients who applied to Health Sciences University Bursa High Specialization Training and Research Hospital between 2015-2019 and who underwent serological tests and duodenal biopsies with a diagnosis of CD or gluten sensitivity were retrospectively analyzed.Results: The study was conducted with a total of 1137 cases, 61.2% (n = 696) of who were women and 38.8% (n = 441) were men. Their ages range from 17 to 91, with a mean of 40.16 ± 16.18 years. Of the 178 patients with gluten sensitivity, 122 (68%) were female and 56 (32%) were male. According to the results of duodenal biopsy, an average of 8% Marsh 3, 5% Marsh 1-2 was detected in the last five years. For the whole study, a significant difference was found between celiac autoantibody positivity rates according to the biopsy results (p = 0.001; p <0.01). The rate of serological test positivity was higher in patients with biopsy result Marsh 3 than those with normal biopsy result, peptic duodenitis and Marsh 1 and 2. No statistically significant difference was found between the rates of Marsh 3 biopsy results and serological test positivity by years (p> 0.05).Conclusions: The number of patients applied with a diagnosis of CD in the last five years has gradually increased (3.4-33.7%). Of the patients with Marsh 3 and Marsh 1-2 biopsy results, 78% were under 50 years old. This suggests that gluten enteropathy in young female patients having digestive system complaints should not be ignored during the diagnosis. Serological test results were highly correlated with the biopsy results in patients with Marsh 3 biopsy results. We think that if clinical findings are supported with serological tests and directed for biopsy in the diagnosis of celiac disease, it will be more cost effective and the workload and time loss will be prevented.

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Evaluation of Efficacy and Adherence to Gluten-Free Diet in Patients with Celiac Disease

10.20944/preprints201810.0324.v1 ◽

2018 ◽

Author(s):

Luis Rodrigo ◽

Isabel Perez-Martinez ◽

Eugenia Lauret-Braña ◽

Adolfo Suarez-Gonzalez

Keyword(s):

Celiac Disease ◽

Multidisciplinary Approach ◽

Duodenal Mucosa ◽

Gluten Free Diet ◽

Gluten Free ◽

Autoimmune Process ◽

Specific Antibodies ◽

Duodenal Biopsies

Celiac disease (CD) is a genetically conditioned autoimmune process that appears in susceptible people. It can affect people of any age, and slightly predominates in females. It has a fairly homogenous global distribution, with an average prevalence of 1-2%, the frequency having increased in recent decades. The only effective treatment is a strict and permanent gluten-free diet (GFD), although the level of compliance with it is poor, at about 50% of cases. To monitor the effectiveness of the GFD, several procedures involving various approaches are employed: a) periodic interviews by nutritionists; b) clinical follow-up; c) serological controls of specific antibodies; d) endoscopies with collection of duodenal biopsies; e) structured questionnaires; f) determination of gluten peptides derived from gluten in feces and/or urine. All of these procedures are useful when applied, alone or in combination, depending on the cases. Some patients will only need to consult to their doctors, while others will require a multidisciplinary approach to assess their compliance with the GFD. In children, normalization of duodenal mucosa was achieved in 95% of cases within 2 years, while it is more delayed in adults, whose mucosa take longer to heal completely.

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Duodenal Bulb Histology in Paediatric Celiac Disease: A Case–Control Study

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz014 ◽

2019 ◽

Vol 3 (5) ◽

pp. 210-215

Author(s):

Erin Boschee ◽

Atilano Lacson ◽

Justine Turner ◽

Jason Yap

Keyword(s):

Celiac Disease ◽

Case Control Study ◽

Villous Atrophy ◽

Duodenal Bulb ◽

Case Control ◽

Duodenal Biopsy ◽

Gastrointestinal Disorders ◽

Paediatric Patients ◽

Control Study ◽

Intraepithelial Lymphocytosis

Abstract Background Controversy exists about optimal methods for duodenal biopsy in diagnosis of celiac disease (CD), in terms of both number of samples and anatomic location. The reliability of duodenal bulb biopsy has been questioned given that normal bulb architecture may mimic disease. However, multiple studies have reported patients with CD have histopathological lesions limited to proximal changes in the duodenal bulb alone. Methods We retrospectively compared duodenal and duodenal bulb histology in a population of paediatric patients with CD and compared with a population of nonceliac controls at Stollery Children’s Hospital, 2010 to 2012. Results Fifty-seven paediatric patients diagnosed with CD and 16 nonceliac controls were included in the study. Fifty-three celiac patients (93.0%) had histopathology consistent with CD (modified Marsh score of 3A, 3B or 3C) in the duodenal bulb. The modified Marsh classification differed significantly between duodenum and duodenal bulb in nine celiac patients (15.8%). Of these, five (8.8%) had Marsh 3 in the bulb and Marsh 0 in the distal duodenum. Among controls, no patients had villous atrophy in either the distal duodenum or duodenal bulb, and all patients had a modified Marsh score of 0 at both sites. Conclusions The results of this study reinforce that duodenal bulb samples are critically important for diagnosing CD in paediatric patients. We suggest that duodenal bulb samples be submitted in separate containers from distal duodenal samples to facilitate accurate interpretation. In contrast to prior reports, we found villous blunting and intraepithelial lymphocytosis are actually uncommon findings in paediatric patients with nonceliac gastrointestinal disorders.

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Celiac disease prevalence is not increased in patients with functional dyspepsia

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.2017v54n1-07 ◽

2017 ◽

Vol 54 (1) ◽

pp. 37-40 ◽

Cited By ~ 3

Author(s):

Juan LASA ◽

Liliana SPALLONE ◽

Silvina GANDARA ◽

Elsa CHAAR ◽

Saul BERMAN ◽

...

Keyword(s):

Celiac Disease ◽

Gastrointestinal Endoscopy ◽

Disease Diagnosis ◽

Disease Prevalence ◽

Upper Gastrointestinal Endoscopy ◽

Healthy Controls ◽

Increased Risk ◽

Celiac Disease Diagnosis ◽

Upper Gastrointestinal ◽

Duodenal Biopsies

ABSTRACT BACKGROUND Previous evidence trying to assess the risk of celiac disease among dyspeptic patients has been inconclusive, showing in some cases notorious discrepancies. OBJECTIVE To determine the prevalence of celiac disease in patients with dyspepsia compared to healthy controls without dyspepsia. METHODS Adult patients under evaluation for dyspepsia were invited to participate. These patients were offered an upper gastrointestinal endoscopy with duodenal biopsies. On the other hand, asymptomatic adult volunteers who performed a preventive visit to their primary care physician were invited to participate and agreed to undertake an upper gastrointestinal endoscopy with duodenal biopsies as well. Those patients with histologic signs of villous atrophy were furtherly evaluated and serological tests were performed in order to determine celiac disease diagnosis. Celiac disease prevalence was compared between groups. RESULTS Overall, 320 patients with dyspepsia and 320 healthy controls were recruited. There were no significant differences in terms of gender or age between groups. Celiac disease diagnosis was made in 1.25% (4/320) of patients in the dyspepsia group versus 0.62% (2/320) in the control group. CONCLUSION Patients with dyspepsia who underwent routine duodenal biopsies did not show an increased risk for celiac disease when compared to healthy individuals.

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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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Prevalence of celiac disease in dyspeptic patients

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032005000300005 ◽

2005 ◽

Vol 42 (3) ◽

pp. 153-156 ◽

Cited By ~ 16

Author(s):

Vinícius Machado de Lima ◽

Lenora Gandolfi ◽

José Augusto de Araújo Pires ◽

Riccardo Pratesi

Keyword(s):

Celiac Disease ◽

Serological Test ◽

Villous Atrophy ◽

Duodenal Biopsy ◽

Upper Gastrointestinal Endoscopy ◽

Test Results ◽

Serological Tests ◽

Routine Testing ◽

Endoscopic Findings ◽

High Prevalence

BACKGROUND: Celiac disease is one of the most common dietary-mediated inflammatory enteropathies that occur in genetically predisposed individuals in response to gluten intolerance. This disorder has become more common than in the past, even if it frequently remains undetected for long periods of time. The screening of patients with dyspepsia, a symptom that can be a manifestation of celiac disease, may allow an early identification of affected individuals. Endoscopy and serological tests may have an important role in the management of these patients. AIMS: Determining the prevalence of celiac disease in dyspeptic patients submitted to routine diagnostic upper gastrointestinal endoscopy. PATIENTS/METHODS: Endoscopic findings, duodenal biopsy histological specimens and serological test results were assessed and compared in 142 patients consecutively admitted with dyspeptic symptoms between October 2001 and October 2003. RESULTS: An endoscopic pattern suggestive of celiac disease was observed in four patients. The IgG-AGA assay was positive in 24 patients. Two of the IgG-AGA positive patients also yielded positive results on the IgA-EMA test and concomitantly disclosed endoscopic pattern and histological features in duodenal biopsy compatible with celiac disease. Abnormal endoscopic findings were notably marked in biopsy proven celiac patients. Therefore, a 1.4% prevalence of celiac disease was observed in this study group. CONCLUSIONS: The high prevalence of celiac among dyspeptic symptomatic individuals indicates that they are a higher risk group for developing celiac disease. Undiagnosed celiac disease may be inferred by endoscopic markers of duodenal villous atrophy. Endoscopic findings, however, may be inadequate to suitably diagnose this disease and consequently the incorporation of diagnostic serologic assays of celiac disease in routine testing for dyspepsia is strongly recommended.

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A Case of Eosinophilic Gastroenteritis with Ascites

Case Reports in Medicine ◽

10.1155/2015/971607 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Erkan Caglar ◽

Aslı Sezgin Caglar ◽

Suut Gokturk ◽

Ahmet Dobrucali

Keyword(s):

Differential Diagnosis ◽

Gastrointestinal Tract ◽

Laboratory Testing ◽

Clinical Presentation ◽

Immunoglobulin E ◽

Endoscopic Examination ◽

Eosinophilic Gastroenteritis ◽

Eosinophilic Infiltration ◽

Pathologic Findings ◽

Upper Gastrointestinal

Eosinophilic gastroenteritis is a rare disorder of unknown cause characterized by focal or diffuse eosinophilic infiltration of gastrointestinal tract, especially the stomach and duodenum. Its clinical presentation depends on which segment of gastrointestinal tract is affected and on the depth of eosinophilic infiltration in the affected segment. We present a case of a 35-year-old male with abdominal distention for six months. Laboratory testing revealed elevated eosinophil count and serum immunoglobulin E (IgE) levels. In abdominal tomography, ascites was observed, and eosinophilic infiltration was detected in duodenum biopsy samples, collected during endoscopic examination of upper gastrointestinal system. Clinical and pathologic findings of the patient responded to steroid dramatically. Even though their comorbidity is rare, eosinophilic gastroenteritis should be considered in differential diagnosis of patients with unspecified ascites.

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Anti-Transglutaminase Antibody Assay of the Culture Medium of Intestinal Biopsy Specimens Can Improve the Accuracy of Celiac Disease Diagnosis

Clinical Chemistry ◽

10.1373/clinchem.2005.061366 ◽

2006 ◽

Vol 52 (6) ◽

pp. 1175-1180 ◽

Cited By ~ 29

Author(s):

Antonio Carroccio ◽

Lidia Di Prima ◽

Giuseppe Pirrone ◽

Calogero Scalici ◽

Ada M Florena ◽

...

Keyword(s):

Celiac Disease ◽

Diagnostic Accuracy ◽

Culture Medium ◽

Villous Atrophy ◽

Disease Diagnosis ◽

Intraepithelial Lymphocytes ◽

Duodenal Biopsy ◽

Intestinal Biopsy ◽

Serum Antibodies ◽

Biopsy Specimens

Abstract Background: We measured anti-transglutaminase (anti-tTG) antibody in the culture medium of intestinal biopsy specimens from patients with suspected celiac disease (CD) and evaluated the relationship between antibody production and severity of intestinal mucosal damage. Methods: We performed diagnostic testing for CD on 273 consecutive patients. In addition to routine histologic evaluation of duodenal biopsy specimens, we assayed anti-tTG antibodies in serum and in the culture medium of duodenal biopsy specimens. Results: CD was diagnosed in 191 of the 273 patients. Sensitivity and specificity of the serum anti-endomysium (EmA) and anti-tTG assays were 83% and 85% and 99% and 95%, respectively, and both had 88% diagnostic accuracy. EmA and anti-tTG assayed in the culture medium had 98% sensitivity, 100% specificity, and 98% diagnostic accuracy (vs serum assays; P <0.0001). Twenty-nine CD patient specimens (16%) were negative for serum anti-tTG and EmA; for 24 of these patients, anti-tTG assay of the culture medium was positive. The CD patients whose biopsy specimens were positive for serum antibodies showed the following intestinal histologies: total villous atrophy, 35%; severe villous atrophy, 25%; mild atrophy, 25%; villi with no atrophy but with increased intraepithelial lymphocytes, 15%. None of the CD patients whose specimens were negative for serum antibodies showed total or severe villous atrophy; 77% had mild villous atrophy, and 23% had no villous atrophy but had increased intraepithelial lymphocyte counts. Mild villous atrophy was also seen in specimens from ∼15% of patients without CD. Conclusion: Anti-tTG assay of the culture medium of biopsy specimens can improve the accuracy of CD diagnosis in patients negative for serum antibodies.

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