Small intestinal contrast ultrasonography-based scoring system: a promising approach for the diagnosis and follow-up of celiac disease.
BACKGROUND
Small intestinal ultrasonography with anechoic contrast agents (SICUS) has been shown to have a diagnostic accuracy on small bowel morphology similar to X-ray barium follow-through. Although extremely investigated by transabdominal ultrasonography, celiac disease, a common disorder of the small bowel, has been never studied by SICUS.


OBJECTIVE
To asses SICUS characteristics of celiac disease patients.


METHODS
SICUS was performed using PEG 4000 as contrast agent. Twenty-three patients with celiac disease at the first diagnosis were enrolled and 30 healthy volunteers, matched for sex and age, were selected as control group. Celiac disease diagnosis was based on anti-gluten, anti-endomysium, and anti-transglutaminase positivity as well as jejunal histology. The following seven echographic parameters were considered: liquid endoluminal content before contrast, loop diameter, Kerckring's folds, peristaltic waves, ileal jejunalization, mesenteric lymphoadenomegaly, and Doppler resistance index (RI) of mesenteric superior artery. Statistical analysis was performed by Student's t test for unpaired data; one-way analysis of variance was used to correlate echographic and histologic pictures.


RESULTS
Loop diameter, Kerckring's fold number, peristaltic waves, and Doppler RI appeared to be significantly different between celiac disease patients and controls. Additionally, liquid content, ileal jejunalization, and mesenteric lymphoadenomegaly were present only in the celiacs (52.1%, 47.7%, and 95.6%, respectively), but not in controls. Only Doppler RI values significantly correlated with the histologic degree of damage.


CONCLUSIONS
SICUS could be a reliable and noninvasive technique to confirm a diagnosis of celiac disease performed using conventional investigations. The possibility of investigating the whole small bowel and the safety of repeating examinations could be useful in the follow-up of celiac patients.
"Umberto I" Hospital, Altamura, Bari, Italy.
Paola
P
Dell'Aquila
Lorena
L
Pietrini
Michele
M
Barone
Ester M
EM
Cela
Nicola Della
ND
Valle
Anacinzia
A
Amoruso
Maria F
MF
Minenna
Antonio
A
Penna
Vincenzo
V
De Francesco
Carmine
C
Panella
Enzo
E
Ierardi
D000328:Adult; D002446:Celiac Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010528:Peristalsis; D011092:Polyethylene Glycols; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013501:Surface-Active Agents; D018608:Ultrasonography, Doppler
D013501:Surface-Active Agents; D011092:Polyethylene Glycols