Making the diagnosis of coeliac disease: is there a role for push enteroscopy?
BACKGROUND
Push enteroscopy is used in the assessment of refractory coeliac disease. However, its value in making the diagnosis of coeliac disease is still not defined.


METHODS
Thirty-one patients (22 females, nine males) were recruited prospectively between September 2001 and October 2002; the age range was 20-80 years (mean age, 52.7 years). All patients had symptoms suggestive of coeliac disease and positive serology but duodenal biopsy was not diagnostic. Twenty-three patients had positive IgA or/and IgG antigliadin antibodies, eight patients had positive endomysial antibodies (EMA). All patients underwent enteroscopy with repeat quadrantic duodenal and additional jejunal biopsies.


RESULTS
All samples were reviewed by a single, blinded, histopathologist. There were no cases of coeliac disease diagnosed on further biopsy in patients who had a positive gliadin antibody in isolation. In the eight EMA-positive cases repeat biopsy demonstrated coeliac disease in five patients. In 3/5 cases the changes were confined to the jejunal biopsies only.


CONCLUSIONS
EMA-positive patients with initially normal histology should have a further duodenal biopsy. In our series three of the five newly diagnosed coeliac disease patients only had villous atrophy demonstrable in the jejunum. There may be a role for push enteroscopy in making the diagnosis of coeliac disease. However, further prospective studies are needed.
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.
Barbara S
BS
Höroldt
Mark E
ME
McAlindon
Timothy J
TJ
Stephenson
Marios
M
Hadjivassiliou
David S
DS
Sanders
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis*; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007583:Jejunum / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method
D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin