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All that scallops is not celiac disease.
V H Shah1, H Rotterdam, D P Kotler
1Department of Surgical Pathology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Gastrointestinal Endoscopy
|June 7, 2000
Summary
Scalloping of duodenal folds is not exclusive to celiac disease. This finding indicates broader duodenal mucosal disease, including villous atrophy and inflammation, with various potential causes.
Area of Science:
- Gastroenterology
- Pathology
Background:
- Scalloping of duodenal folds, mosaic mucosal pattern, decreased folds, and increased vascularity are indicators of duodenal mucosal injury.
- Celiac disease is the most common cause of duodenal mucosal injury, but scalloping can occur in other conditions.
Purpose of the Study:
- To investigate the diagnostic significance of scalloped duodenal folds beyond celiac disease.
- To identify conditions associated with scalloped duodenal folds.
Main Methods:
- Review of clinical, endoscopic, and histologic data from patients with scalloped duodenal folds.
- Histologic examination of biopsy specimens for villous:crypt ratio, intraepithelial lymphocytes, and inflammation.
- Endomysial antibody testing to exclude celiac disease.
Main Results:
- Thirteen patients with scalloped folds presented with various gastrointestinal symptoms and risk factors.
- Histologic abnormalities, including villous atrophy, were present in 12 of 13 patients.
- Celiac disease was excluded; diagnoses included tropical sprue, HIV-related diseases, and infections like giardiasis.
Conclusions:
- Scalloped duodenal folds are not specific to celiac disease.
- Scalloping serves as a predictor of underlying duodenal mucosal disease, characterized by villous atrophy, widening, and edema.
- Differential diagnoses for scalloped folds extend beyond celiac disease to include infections and other enteropathies.