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Patchy
villous atrophy in adult patients with suspected gluten-sensitive
enteropathy: is a multiple duodenal biopsy strategy appropriate?Endoscopy.
2008 Mar;40(3):219-24. Epub 2008 Dec 5.
BACKGROUND AND STUDY
AIMS: The current internationally accepted gold standard for diagnosing
celiac disease is a small-bowel biopsy demonstrating villous atrophy.
However, it has been suggested that the diagnosis might not be considered as
confirmed if the villous atrophy is patchy. Our aim was to assess whether
there is an optimal duodenal biopsy strategy for detecting villous atrophy
in adult patients with suspected gluten-sensitive enteropathy. PATIENTS AND
METHODS: Patients who had positive endomysial or tissue transglutaminase
antibodies were prospectively recruited. Nine biopsies were taken from the
duodenum: one from the duodenal bulb, four from the proximal duodenum, and
four from the distal duodenum. Each biopsy was graded according to the Marsh
criteria. All possible biopsy regimes were evaluated for their ability to
detect the presence and severity of villous atrophy. RESULTS: A total of 56
patients were recruited (23 men [41 %], 33 women [59 %]; mean age 47, range
16 - 85): 53/56 patients had villous atrophy present in at least one biopsy;
10/53 patients had biopsy specimens that showed "patchy" villous atrophy. In
all 53 patients with villous atrophy this was detected by taking a minimum
of three biopsies (sensitivity 100 %, 95 % confidence interval [CI] 93.2 % -
100 %). However, this strategy always incorporated a duodenal bulb biopsy.
The most severe degree of villous atrophy in all 56 patients was only
detected by using a five-biopsy regime (sensitivity 100 %, 95 % CI 93.6 % -
100 %). CONCLUSIONS: In this study we observed that villous atrophy in adult
patients with suspected gluten-sensitive enteropathy (antibody-positive) is
patchy. For this reason we would suggest a minimum of three biopsies,
incorporating a duodenal bulb biopsy, to ensure that villous atrophy is
detected. However, a five-biopsy regime is required for recognition of the
most severe lesion. |
