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Endoscopic features of celiac disease in children
A M Ravelli1, P Tobanelli, L Minelli
1University Department of Pediatrics, Surgery (Digestive Endoscopy), and Pathology II, Spedali Civili, Brescia, Italy.
Insights
Endoscopic findings like mucosal mosaic patterns in the duodenum can help diagnose celiac disease in children. Awareness of these signs is crucial, as they differ from adult presentations.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Celiac Disease Diagnosis
Background:
- Endoscopic abnormalities in adults with celiac disease can suggest diagnosis, particularly in atypical presentations.
- Celiac disease diagnosis often relies on a combination of clinical, serological, and histological findings.
Purpose of the Study:
- To evaluate the macroscopic and histological findings during esophagogastroduodenoscopy (EGD) in children.
- To determine the frequency and diagnostic value of endoscopic abnormalities in pediatric celiac disease.
Main Methods:
- 140 children underwent EGD for various indications.
- Duodenal tissue was assessed macroscopically and histologically.
- Sensitivity, specificity, and predictive values of endoscopic findings were calculated.
Main Results:
- Total villous atrophy, indicative of celiac disease, was found in 80 patients (79 with celiac disease).
- A mucosal mosaic pattern was observed in 100% of pediatric celiac disease patients (sensitivity 98.7%).
- Scalloped duodenal folds (70%) and visible vasculature (15%) were also noted; abnormalities increased with age, except for the mosaic pattern.
Conclusions:
- Endoscopic abnormalities in children with celiac disease differ in frequency and diagnostic value compared to adults.
- Recognizing these endoscopic signs is vital for diagnosing celiac disease in children, especially given common symptoms like abdominal pain and anemia.
- The patchy nature of villous atrophy necessitates careful endoscopic evaluation.
Background:
Endoscopic abnormalities have been described in adult patients with celiac disease that may suggest the diagnosis, especially when the presentation is atypical.
Methods:
The duodenum of 140 children undergoing EGD for various different indications was evaluated macroscopically and histologically.
Results:
Histology revealed total villous atrophy in 80 patients, 79 of whom had celiac disease. Among these, 100% had a mucosal mosaic pattern in the duodenum (sensitivity 98.7%, specificity 96.7%, positive predictive value 97.5%, negative predictive value 98.3%), 70% had scalloped duodenal folds (sensitivity 68.7%, specificity 98.3%, positive predictive value 98.2%, negative predictive value 70.2%), 15% had visible vasculature, and 6% had reduction of duodenal folds. Sensitivity and specificity of endoscopic findings were not modified by chromoendoscopy. Except for the mosaic pattern, the frequency of endoscopic abnormalities increased with age; reduction of duodenal folds was never seen in children with celiac disease who were less than 5 years of age.
Conclusions:
The frequency and diagnostic value of endoscopic abnormalities are different in children with celiac disease compared with adults with this disease. Because indications for endoscopy, such as abdominal pain, dyspepsia, and unexplained anemia, can be manifestations of celiac disease, and villous atrophy may have a patchy distribution, awareness of these endoscopic abnormalities is important in the diagnosis of celiac disease in children.