title: Difficult diagnosis of celiac disease: diagnostic accuracy and utility of chromo-zoom endoscopy.
abstract: BACKGROUND
  Chromo-zoom endoscopy has been demonstrated to be valuable in assessing the degree of intestinal villous atrophy in patients with suspected celiac disease.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of chromo-zoom endoscopy in patients with difficult diagnosis because of nonconcordant test results and/or the confounding of a gluten-free diet initiated before an appropriate diagnosis of celiac disease and to compare the findings to a recent reference standard, the in vitro gliadin challenge test.
  
  
  METHODS
  Prospective, case-control study.
  
  
  METHODS
  Tertiary-care referral hospital.
  
  
  METHODS
  Patients without celiac disease (negative control group, n = 9), patients with celiac disease (positive control group, n = 41), and patients with difficult diagnosis (n = 27).
  
  
  METHODS
  Chromo-endoscopy with indigo carmine and endoscopic zoom-magnification were performed. Duodenal fragments were collected for the in vitro gliadin challenge test. The area under the receiver operating characteristic curve (ROC) was used for statistical analyses on accuracy.
  
  
  METHODS
  Diagnostic accuracy of chromo-zoom endoscopy for detection of mucosal abnormalities in patients with difficult diagnosis.
  
  
  RESULTS
  Chromo-zoom endoscopy had a high accuracy for celiac disease diagnosis in analyses on negative controls and positive controls (area under roc = 0.99). In the difficult diagnosis group, the accuracy of chromo-zoom endoscopy was lower (area under roc = 0.83), but it increased after exclusion of patients with celiac disease on gluten-free diet (area under roc = 0.88).
  
  
  CONCLUSIONS
  There was a 4% failure rate in the ability to cultivate biopsies. Also, the study was done at an academic medical center.
  
  
  CONCLUSIONS
  Chromo-zoom endoscopy has high accuracy for cases of difficult diagnosis of celiac disease but only in untreated patients with celiac disease.
authors.affiliation: Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy. piovino@unisa.it
authors.forename: Paola
authors.initials: P
authors.lastname: Iovino
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pascariello
authors.forename: Ilaria
authors.initials: I
authors.lastname: Russo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galloro
authors.forename: Lucienne
authors.initials: L
authors.lastname: Pellegrini
authors.forename: Carolina
authors.initials: C
authors.lastname: Ciacci
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D002446:Celiac Disease / Q000178:diet therapy / Q000276:immunology / Q000473:pathology*; D004396:Coloring Agents; D055050:Diet, Gluten-Free; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005903:Gliadin / Q000276:immunology; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D061705:Image-Guided Biopsy; D007203:Indigo Carmine; D007413:Intestinal Mucosa / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D004396:Coloring Agents; D006684:HLA-DR Antigens; D005903:Gliadin; D007203:Indigo Carmine