Do we need to take duodenal biopsy routinely to pick up coeliac disease?

Aims: to evaluate the frequency of duodenal villous atrophy and coeliac disease (CD) on a large cohort of patients.

Patients and methods: duodenal biopsy was taken from 1290 consecutive patients between Jan.2.-Dec.31, 2003. The median age of patients was 52 years (range 14–92ys), the male-female ratio was 1:2.18. The clinical suspicion of CD (or other gastrointestinal disorders featuring villous atrophy presenting with malabsoption syndrome) was raised in case of iron deficiency, anemia, diarrhoea, typical laboratory alterations or the combination of these symptomps. The endoscopic suspicion of diseases with villous atrophy was raised when macroscopic alterations (atrophy, edema, scallopping) of the Kerkring folds was detected. Histologically, positive result was defined as villous atrophy of any origin diagnosed by the same expert pathologist. The diagnosis of CD was defined as typical histology according to Marsh classification (villous atrophy accompanied by cryptic hyperplasia and increased intraepithelial lymphocyte/epithelial cell ratio, Marsh 3a-3c) confirmed with positive serology.

Results: based on the indications for upper gastrointestinal endoscopy (UGI), the clinical suspicion of a malabsorption syndrome presenting villous atrophy was raised in 11% of cases (147/1290). Endoscopic suspicion was raised in 2% of cases (25/1290), villous atrophy was found in also 2% of cases (25/1290), whereas positive endosocpic lesions combined with positive histology were observed in 1.3% of cases (17/1290). CD was diagnosed in 1.6% of all patiens going through UGI (20/1290), and 14% of clinically suspected malabsorption cases, and was responsible for 80% (20/25) of villous atrophy results. Conclusion: CD can be effectively screened in case of appropriate clinical alertness making routine duodenal biopsy unnecessary.