The Prevalence Of Histologically Coeliac Disease Compatible Cases With Normal Endoscopic Appearance In Previously Unsuspected Or With Mild Clinical Phenotype Patients

Aims There are many etiologic factors which may cause the coeliac type enteropathy (CTE)- NSAIDs, giardiasis, coeliac disease (CD), etc. The aim of this study to evaluate the histological findings received from duodenal biopsy and to investigate the prevalence of CD compatible cases with normal endoscopic appearance in previously unsuspected or with mild clinical phenotype patients.

Methods The endoscopy and duodenal biopsy for CD/CTE investigation were indicated for 62 patients in GI Endoscopic Department, Mikaelyan University Hospital during January- October, 2020. The endoscopists were used same evaluating methods for CTE: white light endoscopy, digital chromoendoscopy (NBI), water immersion. Totally, 5 biopsy pieces were taken from first and second parts of duodenum. The microscopic examinations were provided by two pathologists, and were classified by Marsh score.

Results Endoscopic features of CTE- mucosal mosaicism, visible submucosal vessels, loss of villi, scalloping of folds- were identified in 6 patients, and the Marsh score was IIIa, IIIb, IIIc. Remaining 56 patients had endoscopic intact duodenum, from these CTE was confirmed histologically in 12/56 (21,4 %) patients. The number of endoscopic intact duodenum patients was twice more than endoscopically visible CTE patients among histologically positive cases. Though the duodenum was endoscopic intact, the mucosal lesions compatible with CD (Marsh score IIIa, IIIb) were in 10 (17,8 %) cases. 2 patients had Marsh score II.

Conclusions Endoscopic techniques allow to find out only villous atrophy, however the study shows that Marsh IIIa, IIIb histological scores could be described even in endoscopically intact duodenum (17,8 %). Therefore, the biopsy acquisition during endoscopy plays essential role in evaluation of CTE stage with normal endoscopic appearance patients.

Citation Manukyan K, Khalatyan A, Khachatryan S eP113 THE PREVALENCE OF HISTOLOGICALLY COELIAC DISEASE COMPATIBLE CASES WITH NORMAL ENDOSCOPIC APPEARANCE IN PREVIOUSLY UNSUSPECTED OR WITH MILD CLINICAL PHENOTYPE PATIENTS. Endoscopy 2021; 53: S133.

Publication History

Article published online:
19 March 2021