Do endoscopic markers still play a role in the diagnosis of celiac disease?

A number of changes in the duodenum are associated with celiac disease (CD), and can be identified endoscopically. Their accuracy becomes crucial as CD markers. This study aimed to determine the diagnostic value of endoscopic markers and to find ways of applying them in the diagnosis of CD.

Seven hundred and sixty-five consecutive patients referred for upper gastrointestinal endoscopy during 18 months were enrolled in the study. The second part of the duodenum was inspected carefully, and biopsies were taken in all patients to detect histologic changes suggestive of CD.

Endoscopic features suggestive of CD were observed in 69 (10.6%) patients; of these, 7 (10.1%) patients were finally diagnosed to have CD. Of the remaining 578 patients in whom the endoscopic markers were not seen, 2 (0.3%) patients were found to have CD. The overall sensitivity, specificity, PPV and NPV of the markers for the diagnosis of CD were 77%, 91%, 10% and 99%, respectively. Of the 9 patients who had CD, 5 had typical symptoms of CD and 4 had atypical features of CD.

Owing to high NPV of endoscopic markers, a careful observation of the second part of duodenum plays an important role in the diagnosis of CD. In patients in whom endoscopic markers are observed, biopsies are indicated; routine duodenal biopsy in all patients cannot be advocated.