Prior endoscopy in patients with newly diagnosed celiac disease: a missed opportunity?
BACKGROUND
Celiac disease (CD) is under-diagnosed in the United States, and factors related to the performance of endoscopy may be contributory.


OBJECTIVE
To identify newly diagnosed patients with CD who had undergone a prior esophagogastroduodenoscopy (EGD) and examine factors contributing to the missed diagnosis.


METHODS
We identified all patients age ≥ 18 years whose diagnosis of CD was made by endoscopy with biopsy at our institution (n = 316), and searched the medical record for a prior EGD. We compared those patients with a prior EGD to those with without a prior EGD with regard to age at diagnosis and gender, and enumerated the indications for EGD.


RESULTS
Of the 316 patients diagnosed by EGD with biopsy at our center, 17 (5 %) had previously undergone EGD. During the prior non-diagnostic EGD, a duodenal biopsy was not performed in 59 % of the patients, and ≥ 4 specimens (the recommended number) were submitted in only 29 % of the patients. On the diagnostic EGD, ≥ 4 specimens were submitted in 94 %. The mean age of diagnosis of those with missed/incident CD was 53.1 years, slightly older than those diagnosed with CD on their first EGD (46.8 years, p = 0.11). Both groups were predominantly female (missed/incident CD: 65 vs. 66 %, p = 0.94).


CONCLUSIONS
Among 17 CD patients who had previously undergone a non-diagnostic EGD, non-performance of duodenal biopsy during the prior EGD was the dominant feature. Routine performance of duodenal biopsy during EGD for the indications of dyspepsia and reflux may improve CD diagnosis rates.
Department of Medicine, Celiac Disease Center at Columbia University, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY 10032, USA. bl114@columbia.edu
Benjamin
B
Lebwohl
Govind
G
Bhagat
Sarah
S
Markoff
Suzanne K
SK
Lewis
Scott
S
Smukalla
Alfred I
AI
Neugut
Peter H R
PH
Green
D002446:Celiac Disease / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged