Clearing the atypical complaints by endoscopy: celiac disease

Yıl 2016, , 4 - 8, 28.04.2016

Salih Boğa Ali Rıza Köksal Hüseyin Alkım , Ayşe Ayşim Özağarı Mehmet Bayram Ayda Batuhan Damar İlker Şen Canan Alkım

https://doi.org/10.17940/endoskopi.307000

Cited By: 1

Öz

Backgorun and Aims: Celiac disease is a small intestine disease that develops with an intolerance to gluten and gluten like proteins that are found in grains, mainly wheat. Although its frequent symptoms are diarrhea and weight loss, dyspeptic symptoms seem to be the first manifestation of disease in an increasing number of patients. Reduction in the number of folds and scalloping of folds are the typical endoscopic findings of celiac disease. The purpose of this study was to assess the value of typical endoscopic findings in diagnosing celiac disease. Materials and Methods: A total of 182 patients who admitted to Department of Gastroenterology at Şişli Hamidiye Etfal Education and Research Hospital with dyspeptic complaints and had upper gastrointestinal endoscopy revealing endoscopic findings typical for celiac disease were included in the study. The files of the patients including their pathologic evaluations were reviewed retrospectively. Results: Ninety (49.5%) of 182 patients that were endoscopically suspected to have celiac disease were reported to have normal mucosa in pathologic evaluation. Their mean age was 41±13.8 and 44 (48.9%) of them were females. The mean age of 67 (36.8%) patients that had pathologic results compatible with celiac disease was 40±14.7 and 48 (71.6%) of them were females. There was no statistical difference in terms of age between both groups, however patients with pathologic reports pointing out celiac disease had a statistically significantly higher female/male ratio (p=0.036). While 67 patients that have pathologic evaluation pertaining to celiac disease were grouped according to Modified Marsh classification, 18 (9.9%) of them were Marsh type 3a, 25 (13.7%) of them were Marsh type 3b, 21 (11.5%) of them were Marsh type 3c and 3 (1.7%) of them were Marsh type 1. The remainder 25 (13.7%) patients had a report of non-spesific mucosal changes. The number of duodenal biopsies taken in each endoscopic procedure were ranging between 2 to 7, mostly 4 (38%). There was no statistical significant difference between the number of biopsies taken and presence of pathologic evaluation compatible with CD (p=0.072). Conclusion: The results of the present study demonstrate that 1 over 3 of every dyspeptic patient with an endoscopic finding of reduction in the number of folds and/or scalloping of folds can have diagnosis of celiac disease. Although symptoms and serologic tests are important for diagnosis of celiac disease, endoscopic evaluation can be helpfull in a group of patients with dyspeptic complaints.

Anahtar Kelimeler

Celiac, atypical, complaints, endoscopy

Atipik şikayetlerin endoskopi ile aydınlatılması: çölyak hastalığı

Öz

Giriş ve Amaç: Çölyak hastalığı başlıca buğday olmak üzere tahıllardaki gluten ve benzeri proteinlere karşı intoleransla gelişen ince barsak hastalığıdır. Klasik semptomları ishal, kilo kaybı olsa da; dispeptik yakınmalar giderek artan oranda ilk başvuru şikayeti olmaktadır. Duodenum pililerinde silikleşme ve taraklanma bulgusu çölyak hastalığının tipik endoskopik bulgularıdır. Bu çalışmada dispepsiyle başvuran hastalarda çölyak hastalığının endoskopik belirteçlerinin hastalığı saptamadaki etkinliği araştırıldı. Gereç ve Yöntem: Şişli Hamidiye Etfal Eğitim Araştırma Hastanesi Gastroenteroloji Kliniği’nde 2011-2014 yılları arasında dispepsi nedeniyle endoskopi yapılan ve çölyak hastalığı ile uyumlu endoskopik görünüm saptanan 182 hasta çalışmaya alındı ve patoloji sonuçları retrospektif olarak değerlendirildi. Bulgular:

Endoskopik olarak çölyak hastalığından şüphelenilen 182 hastanın 90’ının (%49,5) duodenum biyopsilerinde normal mukoza saptandı, ortalama yaşları 41±13.8 idi ve 44’ü (%48.9) kadınlardan oluşuyordu. Patolojik incelemesi çölyak hastalığı ile uyumlu olan 67 (%36,8) hastanın ortalama yaşı 40±14.7 idi ve 48’i (%71.6) kadınlardan oluşmaktaydı. Bu iki grup arasında yaş açısından anlamlı fark saptanmazken, patolojik değerlendirmesi çölyak hastalığı ile uyumlu olan hastalarda istatistiksel olarak anlamlı derecede yüksek kadın/erkek oranı saptandı (p=0.036). Patolojisi çölyak hastalığı ile uyumlu olan 18 (%9,9) hasta Marsh 3a, 25 (%13,7) hasta Marsh 3b, 21 (%11,5) hasta Marsh 3c, 3 hasta ise Marsh 1 (%1,7) olarak sınıflandırıldı. Kalan 25 (%13,7) hastadaysa non-spesifik patolojik değişiklikler saptanmıştı. Duodenum biyopsisi sayısı 2-7 arasında değişmekle beraber çoğunlukla (%38) 4 parça alındığı, alınan parça sayısıyla patoloji bulgusu arasında anlamlı ilişki olmadığı görüldü (p=0.072). Sonuç: Bu çalışma dispeptik nedenlere bağlı olarak yapılan endoskopide taraklanma bulgusu ve pililerde silikleşme saptanan her üç hastadan birinin çölyak hastalığı olabileceğini göstermektedir. Çölyak hastalığı tanısı için semptomatoloji ve serolojik testler önemli olsa da; atipik şikayetlerle başvuran bir grup hastada endoskopik değerlendirme çölyak hastalığı tanısında yol gösterici olabilir.

Anahtar Kelimeler

Çöliyak, atipik, şikayet, endoskopi

Kaynakça

• Biagi F, Klersy C, Balduzzi D, Corazza GR. Are we not over-estimating the prevalence of coeliac disease in the general population? Ann Med 2010;42:557-61.
• Dalgic B, Sari S, Basturk B, et al. Prevalence of celiac disease in healthy Turkish school children. Am J Gastroenterol 2011;106:1512-7.
• Ciacci C, Cirillo M, Sollazzo R, et al. Gender and clinical presentation in adult celiac disease. Scand J Gastroenterol 1995;30:1077-81.
• Corazza GR, Valentini RA, Andreani ML, etal. Subclinical coeliac disease is a frequent cause of iron-deficiency anaemia. Scand J Gastroenterol 1995;30:153-6.
• Horvath K, Hill ID. Anti- tissue transglutaminase antibody as the first line screening for celiac disease: Good-bye antigliadin test? Am J Gastroenterol 2002;97:2702-4.
• Gluten, major histocompatibility complex, and the small intestine: a molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology; 102:330-54.
• Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999;11:1185-94.
• Catassi C, Kryszak D, Bhatti B, et al. Natural history of celiac disease autoimmunity in a US cohort followed since 1974. Ann Med 2010;42:530-8.
• Lo W, Sano K, Lebwohl B, et al. Changing presentation of adult celiac disease. Dig Dis Sci 2003;48:395-8.
• Dickey W, Kenny BD, Mc Millan SA, et al. Gastric as well as duodenal biopsies may be useful in the investigation of iron deficiency anaemia. Scand J Gastroenterol 1997;32:469-72.
• Ackerman Z, Eliakim R, Stalnikowicz R, et al. Role of small bowel biopsy in the endoscopic evaluation of adults with iron deficiency anemia. Am J Gastroenterol 1996; 91:2099-102.
• Harewood GC, Holub JL, Lieberman DA. Variation in small bowel biopsy performance among diverse endoscopy settings: results from a national endoscopic database. Am J Gastroenterol 2004;99:1790-4.
• Brocchi E, Corazza GR, Caletti G, et al. Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease. New Engl J Med 1988;319:741-4.
• Mc Intyre AS, Ng DPK, Smith JA, et al. The endoscopic appearance of duodenal folds is predictive of untreated adult celiac disease. Gastrointest Endosc 1992;38:148-51.
• Maurino E, Capizzano H, Niveloni S, et al. Value of endoscopic markers in celiac disease. Dig Dis Sci 1993;38:2028-33.
• Dickey W. Diagnosis of coeliac disease at open-access endoscopy. Scand J Gastroenterol 1998;33:612-5.
• Dickey W, Hughes D. Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy. Am J Gastroenterol 1999;94:2182-6.
• Bardella MT, Minoli G, Radaelli F, et al. Reevaluation of duodenal endoscopic markers in the diagnosis of celiac disease. Gastrointest Endosc 2000;51:714-6.
• Dickey W, Hughes D. Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy. Am J Gastroenterol 2001;96:2126-8.
• Oxentenko AS, Grisolano SW, Murray JA, et al. The insensitivity of endoscopic markers in celiac disease. Am J Gastroenterol 2002;97:933-8.
• 21. AGA Institute. AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease. Gastroenterology 2006; 131:1977-80.
• Ivarsson A, Persson LA, Nyström L, Hernell O. The Swedish coeliac disease epidemic with a prevailing two fold higher risk in girls compared to boys may reflect gender specific risk factors. Eur J Epidemiol 2003;18:677-84.