Push enteroscopy in celiac sprue and refractory sprue.
BACKGROUND
The aim of this study was to determine in patients with sprue whether jejunal endoscopy improves the diagnostic yield or provides information that may modify management, when compared with evaluation limited to the duodenum.


METHODS
From January 1994 to June 1998, a total of 31 patients (6 men, 25 women, mean age 41 years) were prospectively evaluated by push enteroscopy. They were divided into two groups: (1) celiac disease at different stages of activity (n = 23) and (2) refractory sprue (n = 8). The endoscopic and histologic findings in the duodenum and in the jejunum were compared.


RESULTS
Celiac disease: In 19 patients, endoscopic and histologic findings in the duodenum and jejunum were similar; in four patients villous atrophy was more severe in the duodenum than in the jejunum. Refractory sprue: In 5 of 8 patients, enteroscopy revealed ulcerative jejunitis, whereas ulcerations were found in the duodenum in only one case.


CONCLUSIONS
In refractory sprue, push enteroscopy with jejunal biopsies was of diagnostic value in 50% of cases demonstrating ulcerative jejunitis, whereas it did not modify the management of patients with responsive celiac disease.
Cellier
C
C
Department of Hepato-Gastroenterology, Laennec Hospital and Necker Hospital, Assistance Publique- Hôpitaux de Paris and Université René Descartes, Paris, France. christophe.cellier@lnc.ap-hop-paris.fr
Cuillerier
E
E
Patey-Mariaud de Serre
N
N
Marteau
P
P
Verkarre
V
V
Brière
J
J
Brousse
N
N
Barbier
J P
JP
Schmitz
J
J
Landi
B
B
D000328:Adult; D000368:Aged; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007583:Jejunum / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies