7 research outputs found
ENDOSCOPY PITFALLS IN CELIAC DISEASE DIAGNOSIS; A MULTICENTRE STUDY
Introduction The traditional diagnosis of celiac disease (CD) requires a small bowel biopsy to identify at histology the characteristic mucosal changes. The current biopsy practise among endoscopists for celiac disease is in most part unknown. The aims of this study were to compare the different diagnostic criteria in various centres in Italy, Iran, Lithuania, Romania and the UK, the methodological approach to the biopsy and to investigate the pitfalls of CD diagnosis.
To measure the number of specimens submitted during duodenal biopsy among patients in Italy, Iran, Lithuania, Romania and the UK, and to determine the incremental diagnostic yield of adherence to the recommended number of specimens.
Methods A total of 931 patients who underwent duodenal biopsy for CD were recruited prospectively at nine centres in European and Middle East countries. Small-bowel biopsies were obtained from the duodenal bulb and the second part of the duodenum (and from the duodenal bulb when it had a micronodular appearance). The histopathological appearances were described according to the modified Marsh classification.
Results The most frequent degree of villous atrophy amongst Iranian subjects was 3A and that of the rest of the study population was 3C. The most common number of biopsy specimens for Romanian subjects was 1 (52%) followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). The main presenting symptom was anaemia (18.7%) followed by malabsorption (10.5%), diarrhoea (9.3%) and dyspepsia (8.2%).
Conclusion Taking less biopsy samples than recommended will have a negative impact in detecting massive number of undiagnosed cases. As CD is more common with atypical presentation, taking 4 duodenal biopsies is mandatory for an accurate diagnosis or its exclusion
Gastrointestinal and non-gastrointestinal presentation in patients with celiac disease
Background: Celiac disease (CD) may have a variety of different presentations. This study has aimed to explore the prevalence of gastrointestinal
(GI) and non-GI symptoms in patients with CD according to data collected in Italy and Romania (Europe) and Iran (Middle East).
Methods: This is a retrospective cross-sectional study conducted in Iran, Romania and Italy with data collection during the period from
May 2009 – May 2011. For each center we included only patients with CD that was con¿rmed by endoscopy, small bowel biopsies and
positive serology. GI symptoms such as abdominal pain, diarrhea, constipation, nausea and vomiting, weight loss and Àatulence, as well
as additional signs and symptoms of iron deÂżciency anemia (IDA), osteoporosis, hypertransaminasemia, and other related abnormalities
were collected.
Results: Overall, 323 women and 127 men, whose mean age at diagnosis was 34.2 ± 16.47 years were included in this study. Of these,
157 subjects (34.9%) reported at least one GI symptom. The majority of cases had the following primary presenting GI symptoms: diarrhea
(13.6%), dyspepsia and constipation (4.0%). Other disease symptoms were reported by 168 (37.3%) patients. The most presenting non-GI
symptoms in the majority of cases were anemia (20.7%) and osteopenia (6%). There were statistically signiÂżcant differences between the
majority of symptoms when we compared the reported clinical symptoms from different countries.
Conclusion: This study indicated that upper abdominal disorders such as abdominal pain and dyspepsia were the most common primary
complaints among European patients, whereas Iranian patients had complaints of diarrhea and bloating as the classic presentations of CD.
For non-GI symptoms, anemia was the most frequent complaint for both Iranian and Italian patients; however it was significantly higher in
Iranians
Endoscopic and histological pitfalls in the diagnosis of celiac disease: A multicentre study assessing the current practice [Dificultades endosc\uf3picas e histol\uf3gicas en el diagn\uf3stico de la enfermedad celiaca: Un estudio multic\ue9ntrico para valorar la pr\ue1ctica actual]
Background and aims: the diagnosis of celiac disease requires
small bowel biopsies to identify the characteristic mucosal changes.
The current biopsy practice among endoscopists for celiac disease
is in most part unknown. The aim of this study was to compare
the different diagnostic policies in various centers in their current
practice.
Method: information from a total of 931 confirmed celiac
disease patients was retrospectively obtained retrospectively
from nine centers in European and Middle Eastern countries.
The number of small-bowel biopsies obtained from the duodenal
bulb and the second part of the duodenum was compared among
different centers.
Results: the most frequent stage of mucosal changes amongst
Iranian subjects was Marsh IIIa whereas in the rest of the study
population was Marsh IIIc. Marsh I and Marsh II were more
prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher
in pediatric ages between 1 and 15 (P < 0.05). The most common
number of biopsy specimens obtained from Romanian subjects was
1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian
(66.7%) and British patients (65%) and 4 for Italian patients
(48.3%). For majority of cases, anemia was the most prevalent
symptom (18.7%) followed by malabsorption (10.5%), diarrhea
(9.3%) and dyspepsia (8.2%), respectively.
Conclusions: despite the evidence-based recommendations,
this study revealed a poor compliance with major guidelines on
diagnosis of celiac disease. We emphasize that taking adequate
number of duodenal biopsies should be implemented for an accurate
diagnosis and also for the exclusion of celiac disease
Gastrointestinal and non-gastrointestinal presentation in patients with celiac disease.
Background: Celiac disease (CD) may have a variety of different presentations. This study has aimed to explore the prevalence of gastrointestinal
(GI) and non-GI symptoms in patients with CD according to data collected in Italy and Romania (Europe) and Iran (Middle East).
Methods: This is a retrospective cross-sectional study conducted in Iran, Romania and Italy with data collection during the period from
May 2009 \u2013 May 2011. For each center we included only patients with CD that was con\ubfrmed by endoscopy, small bowel biopsies and
positive serology. GI symptoms such as abdominal pain, diarrhea, constipation, nausea and vomiting, weight loss and \uc0atulence, as well
as additional signs and symptoms of iron de\ubfciency anemia (IDA), osteoporosis, hypertransaminasemia, and other related abnormalities
were collected.
Results: Overall, 323 women and 127 men, whose mean age at diagnosis was 34.2 \ub1 16.47 years were included in this study. Of these,
157 subjects (34.9%) reported at least one GI symptom. The majority of cases had the following primary presenting GI symptoms: diarrhea
(13.6%), dyspepsia and constipation (4.0%). Other disease symptoms were reported by 168 (37.3%) patients. The most presenting non-GI
symptoms in the majority of cases were anemia (20.7%) and osteopenia (6%). There were statistically signi\ubfcant differences between the
majority of symptoms when we compared the reported clinical symptoms from different countries.
Conclusion: This study indicated that upper abdominal disorders such as abdominal pain and dyspepsia were the most common primary
complaints among European patients, whereas Iranian patients had complaints of diarrhea and bloating as the classic presentations of CD.
For non-GI symptoms, anemia was the most frequent complaint for both Iranian and Italian patients; however it was significantly higher in
Iranians
Endoscopic and histological pitfalls in the diagnosis of celiac disease: A multicentre study assessing the current practice [Dificultades endoscópicas e histológicas en el diagnóstico de la enfermedad celiaca: Un estudio multicéntrico para valorar la práctica actual]
Background and aims: the diagnosis of celiac disease requires
small bowel biopsies to identify the characteristic mucosal changes.
The current biopsy practice among endoscopists for celiac disease
is in most part unknown. The aim of this study was to compare
the different diagnostic policies in various centers in their current
practice.
Method: information from a total of 931 confirmed celiac
disease patients was retrospectively obtained retrospectively
from nine centers in European and Middle Eastern countries.
The number of small-bowel biopsies obtained from the duodenal
bulb and the second part of the duodenum was compared among
different centers.
Results: the most frequent stage of mucosal changes amongst
Iranian subjects was Marsh IIIa whereas in the rest of the study
population was Marsh IIIc. Marsh I and Marsh II were more
prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher
in pediatric ages between 1 and 15 (P < 0.05). The most common
number of biopsy specimens obtained from Romanian subjects was
1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian
(66.7%) and British patients (65%) and 4 for Italian patients
(48.3%). For majority of cases, anemia was the most prevalent
symptom (18.7%) followed by malabsorption (10.5%), diarrhea
(9.3%) and dyspepsia (8.2%), respectively.
Conclusions: despite the evidence-based recommendations,
this study revealed a poor compliance with major guidelines on
diagnosis of celiac disease. We emphasize that taking adequate
number of duodenal biopsies should be implemented for an accurate
diagnosis and also for the exclusion of celiac disease