BACKGROUND: The endoscopic appearance of the duodenal folds can predict the presence of celiac disease. However, endoscopic alterations can be minimal and the disease can have a "patchy" distribution histopathologically. The observation that intestinal villi can be better visualized when the duodenum is filled with water led to the development of an endoscopic "immersion technique" to assess celiac disease. METHODS: Endoscopy with duodenal biopsies was performed in 20 patients with malabsorption syndrome (positive for antiendomysial antibodies) and in 30 patients with reflux-like symptoms (negative for antiendomysial antibodies). Duodenal hypotonia was induced pharmacologically, water was introduced, and the mucosa was observed for the presence of villi. Photographs were obtained for subsequent analysis. The endoscopic appearance was classified from 1 (folds certainly present) to 4 ("scalloped valvulae"); villous structures were classified from 1 (definitely present) to 3 (definitely absent). RESULTS: Celiac disease was confirmed histopathologically in all patients with positive antiendomysial antibodies. The endoscopic appearance of the duodenum with air insufflation alone had a positive predictive value for the diagnosis of celiac disease of 84% and a specificity of 87%. Visualization of villi with the "immersion technique" had a higher positive predictive value (99%) and specificity (99%). CONCLUSIONS: A lack of visualization of intestinal villi in the descending duodenum with the "immersion technique" may increase the diagnostic accuracy of endoscopy for celiac disease. This technique could also be useful for targeting duodenal biopsies.

Gasbarrini, A., Ojetti, V., Cuoco, L., Cammarota, G., Migneco, A., Armuzzi, A., Pola, P., Gasbarrini, G. B., A) Lack of endoscopic visualization of intestinal villi with the "immersion technique" in overt atrophic celiac disease, <<GASTROINTESTINAL ENDOSCOPY>>, 2003; (57(3)): 348-351 [http://hdl.handle.net/10807/20698]

A) Lack of endoscopic visualization of intestinal villi with the "immersion technique" in overt atrophic celiac disease

Gasbarrini, Antonio;Ojetti, Veronica;Cammarota, Giovanni;Migneco, Alessio;Armuzzi, Alessandro;Pola, Paolo;Gasbarrini, Giovanni Battista
2003

Abstract

BACKGROUND: The endoscopic appearance of the duodenal folds can predict the presence of celiac disease. However, endoscopic alterations can be minimal and the disease can have a "patchy" distribution histopathologically. The observation that intestinal villi can be better visualized when the duodenum is filled with water led to the development of an endoscopic "immersion technique" to assess celiac disease. METHODS: Endoscopy with duodenal biopsies was performed in 20 patients with malabsorption syndrome (positive for antiendomysial antibodies) and in 30 patients with reflux-like symptoms (negative for antiendomysial antibodies). Duodenal hypotonia was induced pharmacologically, water was introduced, and the mucosa was observed for the presence of villi. Photographs were obtained for subsequent analysis. The endoscopic appearance was classified from 1 (folds certainly present) to 4 ("scalloped valvulae"); villous structures were classified from 1 (definitely present) to 3 (definitely absent). RESULTS: Celiac disease was confirmed histopathologically in all patients with positive antiendomysial antibodies. The endoscopic appearance of the duodenum with air insufflation alone had a positive predictive value for the diagnosis of celiac disease of 84% and a specificity of 87%. Visualization of villi with the "immersion technique" had a higher positive predictive value (99%) and specificity (99%). CONCLUSIONS: A lack of visualization of intestinal villi in the descending duodenum with the "immersion technique" may increase the diagnostic accuracy of endoscopy for celiac disease. This technique could also be useful for targeting duodenal biopsies.
Inglese
Gasbarrini, A., Ojetti, V., Cuoco, L., Cammarota, G., Migneco, A., Armuzzi, A., Pola, P., Gasbarrini, G. B., A) Lack of endoscopic visualization of intestinal villi with the "immersion technique" in overt atrophic celiac disease, <<GASTROINTESTINAL ENDOSCOPY>>, 2003; (57(3)): 348-351 [http://hdl.handle.net/10807/20698]
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/20698
Citazioni
  • ???jsp.display-item.citation.pmc??? 11
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact