![]() ![]() For this reason, and according to other endoscopists in Italy, I proposed the following classification in 2002(11):Ī. Therefore, we may hypothesize that endoscopic damage occurs first in the duodenal bulb and then in the distal tracts of the duodenum. Celiac disease is considered a crianial-caudal disease which affects primarily the proximal segments (first the duodenal bulb and then the second and third duodenal portions) and then the distal segments of the small bowel (first jejeunum and then the ileum). However, I think that it may be graded according to some simple considerations. There is non-existing classification of endoscopic lesions in celiac disease. On the other hand, the presence of one or more endoscopic markers increases the sensitivity and specificity ranging from 87.5 to 94% and from 99 to 100% respectively (12,15). al., described 13 cases in which scalloping of duodenal folds was not caused by celiac disease but due to other causes (HIV-related infection, tropical sprue, giardiasis, eosinophilic gastroenteritis)(14). For example, looking at scalloping, Shah, et. Unfortunately, an endoscopic marker suspected for celiac disease itself is not specific for celiac disease. Moreover, we showed that in young patient with subclinical/silent celiac disease there is a greater probability of finding slight/mild endoscopic abnormal/mild histological damage (11). We found in fact that endoscopic appearance of the duodenum may be predictive of histological damage grading. Moreover, in some cases specific endoscopic features can be associated with specific histological damage and may be associated with the clinical form of the disease. ![]() Unfortunately, this is the least sensitive endoscopic marker in all studies in which it was specifically evaluated (6,12,13).Īll these markers are helpful in recognising celiac disease. This marker describes a prominence of underlying duodenal blood vessels in patients with celiac disease. This marker is quite frequent in childhood and adolescent patients, but it can be also recognized in young adults 9-11. Unfortunately, the sensitivity of this marker is quite low (57%) (8). Mucosal mosaic pattern may be recognized both in the duodenal bulb and in the second portion of the duodenum, and its assessment may be easily performed by chromoendoscopy. The sensitivity and specificity of this marker are 88% and 87% respectively (6,7). Grooves in the mucosa between folds have also associated with celiac disease and likely a manifestation of the same process that leads to scalloping. Scalloping occurs when multiple grooves run over the apex of a duodenal fold. The sensitivity and specificity of this marker range from 73 to 88% and from 83 to 97% respectively (4,5). “Loss” of folds is defined as an obvious reduction in height or number of folds in the second portion when viewed with maximal air insufflation. The endoscopic features in the duodenum that are well-established as markers for celiac disease include: loss of folds scalloping of folds mucosal mosaic pattern whilst less commonly described findings include a visible vascular pattern and micronodularity in the duodenal bulb. Awareness of these endoscopic features may alert the endoscopist to the presence of celiac disease and the need for duodenal biopsies in patients undergoing endoscopy for symptoms unrelated to the disease as well as those with vague, non-specific manifestations. Because it is now understood that the manifestations of celiac disease are wide and variable, and that the disease is more common than recognized in the past, the clinical significance of these endoscopic observations has been greatly amplified. However, over the last two decades it has been recognized that a number of changes in the duodenum clearly associated with celiac disease can be identified endoscopically. It has long been known that celiac disease can produce changes in the appearance of small intestine on barium contrast radiographs, one such change being so-called “loss” of duodenal folds. The role of endoscopy in diagnosing celiac disease Therefore, many patients have upper gastrointestinal endoscopy as an initial investigation, which provides an opportunity to perform a biopsy in the second portion of the duodenum. It has become increasingly apparent that the prevalence of celiac disease is higher than previously thought, and that this is mainly because of increasing awareness of atypical, mildly symptomatic, or silent cases(3). A correct gluten-free diet results in clinical and histological improvement(1,2). Celiac disease is a disorder characterized by a clinical syndrome of intestinal malabsorption and a characteristic though not specific histological lesion consisting in total, subtotal or partial small-bowel villous atrophy (predominating in the proximal segments). ![]()
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