A key role for abdominal ultrasound examination in "difficult" diagnoses of celiac disease.
OBJECTIVE
To evaluate the usefulness of abdominal ultrasound examination (US) for the diagnostic workup of cases of suspected CD involving negative serum antibodies and difficult diagnosis.


METHODS
524 consecutive patients with symptoms of suspected CD underwent an extensive diagnostic workup. 76 (14 %) were excluded since they were positive for serum anti-tTG and/or EmA antibodies. 377 were excluded since they were diagnosed with something other than CD or did not have the alleles encoding for HLA DQ 2 or DQ 8. A diagnosis of CD with negative serum antibodies was probable in 71 patients who underwent abdominal US and duodenal biopsy for histology evaluation.


RESULTS
Intestinal histology and subsequent clinical and histological follow-up confirmed the CD diagnosis in 12 patients (GROUP 1) and excluded it in 59 subjects (GROUP 2). Abdominal US showed that the presence of dilated bowel loops and a thickened small bowel wall had a sensitivity of 83 % and a negative predictive value (NPV) of 95 % in CD diagnosis. Furthermore, in 11 of the 12 CD seronegative patients there was at least one of these two abdominal US signs. Therefore, considering the presence of one of these two signs, abdominal US sensitivity increased to 92 % and NPV to 98 %.


CONCLUSIONS
Abdominal US is useful in the diagnostic workup of patients with a high clinical suspicion of CD but with negative serology.
Department of Clinical Medicine and Emerging Pathologies, University of Palermo, Palermo, Italy.
M
M
Soresi
G
G
Pirrone
L
L
Giannitrapani
G
G
Iacono
L
L
Di Prima
E
E
La Spada
G
G
Di Fede
G
G
Ambrosiano
G
G
Montalto
A
A
Carroccio
D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000000981:diagnostic imaging* / Q000276:immunology / Q000473:pathology; D004386:Duodenum / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012985:Software Design; D014463:Ultrasonography; D055815:Young Adult
D001323:Autoantibodies; D007070:Immunoglobulin A