Höroldt, B.S.; McAlindon, M.E.; Stephenson, T.J.; Hadjivassiliou, M.; Sanders, D.S.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA99
Academic Journal
Background and Aims: Previous investigators have suggested that the only role for enteroscopy in coeliac disease (CD) is in the assessment of refractory cases. We assessed the value of enteroscopy in making the diagnosis of CD. Methods: 31 patients (22 female, 9 male) were recruited prospectively from September 2001 to October 2002. Mean age 52.7 years (range 20-80 years). Clinical indications for investigating For CD were anaemia (n = 12), diarrhoea (n = 9), irritable bowel syndrome (n = 7), family history of CD (n = 1), elevated transaminases (n = 1), and abdominal pain (n = 1). All patients were tested using a combination of immunoglobulins, IgG and IgA gliadin antibodies (AGA) and endomysial antibody (EMA). Of the 31 cases, 8 were EMA positive (alone or in combination with either AGA) and 23 had positive IgG and/or IgA AGA. Initial quadrantic duodenal biopsies showed intraepithelial lymphocytes in 16 cases and normal mucosa in the other 15. In view of the clinical indications and positive antibody titres we proceeded to enteroscopy with repeat quadrantic duodenal biopsies (×4) and separate distal small bowel biopsy (×4). Results: A single investigator performed push enteroscopy. Mean depth of insertion was 115 cm beyond the pylorus (range 95-135 cm). All samples were reviewed by a gastrointestinal histopathologist and compared with the initial duodenal biopsy. The diagnosis of CD could not be confirmed from either the 2nd duodenal biopsy or small bowel biopsy in all 23 cases that were only AGA positive. For the 8 EMA positive cases, repeat biopsy proved the diagnosis of CD in 5 cases (AGA group vs EMA: Fisher exact t test p < 0.0001). Of these 5 cases, 3 only had evidence of villous atrophy in the distal small bowel biopsy. Conclusion: EMA positive patients in whom the diagnosis of CD has not been confirmed after duodenal biopsy may benefit from repeat biopsy. In 3 of the 5 cases the diagnostic information was only apparent in the distal small...


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