Background and study aim: Endoscopy with duodenal biopsy is often performed in order to assess histological
recovery in patients with celiac disease who are on a gluten-free diet. Use of the
”immersion” technique during upper endoscopy allows visualization of duodenal villi
or detection of total villous atrophy. In this two-center study, we investigated the
accuracy of the immersion technique in predicting histological recovery in patients
on a gluten-free diet whose initial diagnosis of celiac disease had been made on the
basis of total villous atrophy.
Patients and methods: The immersion technique was performed in 62 patients with celiac disease who were
being treated and who had been referred for follow-up (26 patients at the Rome center
and 36 patients at the Vicenza center). All these patients had an initial diagnosis
based on positive antibodies and biopsy-proved duodenal total villous atrophy. At
the follow-up examination, the duodenal villi were re-evaluated as present or absent
by one endoscopist at each center, and the results were compared with the histology.
Results: At the follow-up endoscopy, the duodenal villi were found to be present in 51 patients
and absent in 11. The sensitivity, specificity, positive predictive value, and negative
predictive value of the immersion technique for detecting the presence or absence
of villi were all 100 %.
Conclusions: This study demonstrated the feasiblity and the high level of accuracy of the immersion
technique in predicting the histological recovery of duodenal villi in patients with
celiac disease who are following a gluten-free diet. An endoscopy-based approach that
avoids the need for biopsy could be useful for monitoring the dietary adherence and/or
response of patients with an initial diagnosis of celiac disease based on total villous
atrophy.
References
http://consensus.nih.gov/2004/2004celiacDisease118html. htm
gcammarota@rm.unicatt.it
