A prospective evaluation of endoscopic markers for identifying celiac disease in patients with high and low probability of having the disease.
OBJECTIVE
the usefulness of duodenoscopic markers for predicting celiac disease (CD) has been questioned. We assessed the diagnostic efficacy of endoscopic markers of mucosal atrophy in individuals with different pretest probability of CD.


METHODS
we prospectively performed endoscopic intestinal biopsies and CD-related serology tests in 661 individuals, including 143 consecutive patients attending a malabsorption clinic (high pretest probability) and 518 subjects randomly selected fom those undergoing routine endoscopy because of upper GI symptoms (low pretest probability). Duodenoscopic markers reported were: mosaic pattern, scalloped folds, and reduction in number or loss of Kerkring's folds.


RESULTS
sixty-three (44.1%) and 18 (3.5%) patients were diagnosed with CD in the high and low risk groups, respectively Among high pretest subjects, the presence of any marker had very high sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the identification of CD (92.1%, 93.8%, 92.1%, 93.8% and 93.0%, respectively). The performance of these parameters for the presence of any marker in the low pretest population were 61.1%, 96.8%, 40.7%, 98.6% and 95.6%, respectively. Sensitivity (p < 0.004) and positive predictive value (p < 0.0001) of markers were significantly higher for the high risk patients. The identification of a reduction in number or loss of Kerkring'sfolds was not a reliable finding unless other signs were also present.


CONCLUSIONS
we confirm that endoscopic markers are useful in predicting CD in different clinical scenarios. The high negative predictive value in the low probability group suggests that intestinal biopsy is not required if endoscopic markers are absent.
Reyes
Hugo
H
Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Ciudad Autónoma de Buenos Aires, Argentina.
Niveloni
Sonia
S
Moreno
María L
ML
Vázquez
Horacio
H
Jer
Hwang Hui
HH
Argonz
Julio
J
Sugai
Emilia
E
Mazure
Roberto
R
Smecuol
Edgardo
E
Crivelli
Adriana
A
La Motta
Gisella
G
Caniggia
María E
ME
Gómez
Juan C
JC
Chopita
Néstor
N
Kogan
Zulema
Z
Cabanne
Ana
A
Mauriño
Eduardo
E
Bai
Julio C
JC
D000328:Adult; D000368:Aged; D001284:Atrophy; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D004384:Duodenoscopy; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult