title: Prediction of esophageal and gastric histology by macroscopic diagnosis during upper endoscopy in pediatric celiac disease.
abstract: OBJECTIVE
  To determine the sensitivity of macroscopic appearance for predicting histological diagnosis at sites other than duodenum in pediatric celiac disease (CD).
  
  
  METHODS
  Endoscopic and histologic findings in pediatric patients undergoing upper endoscopy for first-time diagnosis of CD at Stollery Children's Hospital from 2010-2012 were retrospectively reviewed.
  
  
  RESULTS
  Clinical charts from 140 patients were reviewed. Esophageal and gastric biopsies were taken in 54.3% and 77.9% of patients, respectively. Endoscopic appearance was normal in the esophagus and stomach in 75% and 86.2%. Endoscopic esophageal diagnoses were eosinophilic esophagitis (EE) (11.8%), esophagitis (7.9%), glycogenic acanthosis (1.3%) and non-specific abnormalities (3.9%). Endoscopic gastric diagnoses were gastritis (8.3%), pancreatic rest (0.9%), and non-specific abnormalities (4.6%). Histology was normal in 76.3% of esophageal and 87.2% of gastric specimens. Abnormal esophageal histology was EE (10.5%), esophagitis (10.5%), glycogenic acanthosis (1.3%) and non-specific (1.3%). Gastritis was reported in 12.8% of specimens. Sensitivity and specificity of normal endoscopy for predicting normal esophageal histology was 86.2% and 61.1%, and for normal gastric histology was 87.4% and 21.4%.
  
  
  CONCLUSIONS
  In the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during endoscopy for pediatric CD does not identify major pathologies. These findings have cost and time saving implications for clinical practice.
authors.affiliation: Erin D Boschee, Department of Pediatrics, University of Alberta, Edmonton, Alberta T6G 2B7, Canada.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Boschee
authors.affiliation: Erin D Boschee, Department of Pediatrics, University of Alberta, Edmonton, Alberta T6G 2B7, Canada.
authors.forename: Jason Y K
authors.initials: JY
authors.lastname: Yap
authors.affiliation: Erin D Boschee, Department of Pediatrics, University of Alberta, Edmonton, Alberta T6G 2B7, Canada.
authors.forename: Justine M
authors.initials: JM
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D004941:Esophagitis / Q000000981:diagnostic imaging; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005756:Gastritis / Q000000981:diagnostic imaging; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013270:Stomach / Q000473:pathology*
keywords: Celiac disease; Endoscopy; Esophagus; Gastric biopsy; Histology