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Difficult diagnosis of celiac disease: diagnostic accuracy and utility of chromo-zoom endoscopy
Paola Iovino1, Annalisa Pascariello, Ilaria Russo
1Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy. piovino@unisa.it
Insights
Chromo-zoom endoscopy accurately diagnoses celiac disease, especially in untreated patients. This technique proves valuable for challenging cases where standard tests are inconclusive or a gluten-free diet complicates diagnosis.
Area of Science:
- Gastroenterology
- Endoscopy
- Celiac Disease Diagnostics
Background:
- Chromo-zoom endoscopy aids in assessing villous atrophy for suspected celiac disease.
- Accurate diagnosis is crucial, yet challenging in cases with non-concordant tests or prior gluten-free diet initiation.
Purpose of the Study:
- To evaluate chromo-zoom endoscopy's diagnostic accuracy in difficult celiac disease cases.
- To compare its performance against the in vitro gliadin challenge test.
Main Methods:
- Prospective case-control study at a tertiary-care hospital.
- Involved patients with celiac disease, without celiac disease, and those with difficult diagnoses.
- Utilized chromo-endoscopy with zoom-magnification and collected duodenal biopsies for in vitro gliadin challenge tests.
Main Results:
- High accuracy (AUC=0.99) in control groups.
- Moderate accuracy (AUC=0.83) in the difficult diagnosis group, improving to (AUC=0.88) after excluding patients on a gluten-free diet.
Conclusions:
- Chromo-zoom endoscopy demonstrates high accuracy for diagnosing celiac disease in untreated patients.
- It is a valuable tool for difficult diagnostic scenarios, particularly when patients have not yet adopted a gluten-free diet.
Background:
Chromo-zoom endoscopy has been demonstrated to be valuable in assessing the degree of intestinal villous atrophy in patients with suspected celiac disease.
Objective:
To evaluate the diagnostic accuracy of chromo-zoom endoscopy in patients with difficult diagnosis because of nonconcordant test results and/or the confounding of a gluten-free diet initiated before an appropriate diagnosis of celiac disease and to compare the findings to a recent reference standard, the in vitro gliadin challenge test.
Design:
Prospective, case-control study.
Setting:
Tertiary-care referral hospital.
Patients:
Patients without celiac disease (negative control group, n = 9), patients with celiac disease (positive control group, n = 41), and patients with difficult diagnosis (n = 27).
Intervention:
Chromo-endoscopy with indigo carmine and endoscopic zoom-magnification were performed. Duodenal fragments were collected for the in vitro gliadin challenge test. The area under the receiver operating characteristic curve (ROC) was used for statistical analyses on accuracy.
Main Outcome Measurements:
Diagnostic accuracy of chromo-zoom endoscopy for detection of mucosal abnormalities in patients with difficult diagnosis.
Results:
Chromo-zoom endoscopy had a high accuracy for celiac disease diagnosis in analyses on negative controls and positive controls (area under roc = 0.99). In the difficult diagnosis group, the accuracy of chromo-zoom endoscopy was lower (area under roc = 0.83), but it increased after exclusion of patients with celiac disease on gluten-free diet (area under roc = 0.88).
Limitations:
There was a 4% failure rate in the ability to cultivate biopsies. Also, the study was done at an academic medical center.
Conclusion:
Chromo-zoom endoscopy has high accuracy for cases of difficult diagnosis of celiac disease but only in untreated patients with celiac disease.
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