title: Role of magnified ileoscopy in the diagnosis of cases of coeliac disease with predominant abdominal symptoms.
abstract: OBJECTIVE
  Less severe histological changes have sometimes been reported in the terminal ileum (TI) of coeliac patients. The aim of this work was to assess whether magnified ileoscopy and the corresponding biopsy could be used when diagnosing coeliac disease (CD). This would be of clinical value in coeliac patients who show predominant abdominal symptoms and who undergo colonoscopy with ileoscopy as first clinical examination.
  
  
  METHODS
  All patients underwent conventional and magnified ileoscopy, along with histological examination of macroscopic mucosal abnormalities, if present. Patients whose ileoscopy with biopsy suggested CD underwent a blood test for quantitative determination of anti-transglutaminase antibodies and upper gastrointestinal endoscopy with corresponding duodenal biopsy.
  
  
  RESULTS
  Out of 143 patients enrolled, 21 had a TI mucosal lesion, and 10 of these showed villous atrophy at ileoscopy only after magnification. Six showed a count of intra-epithelial lymphocytes (IELs) >25/100 enterocytes and upper intestinal lesions, confirming the diagnosis of CD. Finally, of four patients diagnosed with Crohn's disease, TI mucosal aftoid lesions were seen in two only in magnified view.
  
  
  CONCLUSIONS
  Magnified ileoscopy reliably recognizes the presence of mucosal villous subtotal or total atrophy at TI. This finding, even if not specific to CD, can address the diagnosis of CD. Magnification in the course of ileoscopy could also be useful in the diagnosis of Crohn's disease.
authors.affiliation: Division of Operative Endoscopy and Gastroenterology, Fabio Di Giovambattista - USI, Rome, Italy. arimecme@tin.it
authors.forename: Antonello
authors.initials: A
authors.lastname: Trecca
authors.forename: Fabio
authors.initials: F
authors.lastname: Gaj
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gagliardi
authors.forename: Roberta
authors.initials: R
authors.lastname: Calcaterra
authors.forename: Serena
authors.initials: S
authors.lastname: Battista
authors.forename: Marco
authors.initials: M
authors.lastname: Silano
mesh_terms: D000293:Adolescent; D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis* / Q000473:pathology; D007070:Immunoglobulin A / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D007070:Immunoglobulin A