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Published on: October 16, 2013
Scalloping is a reliable endoscopic marker for celiac disease
Yair Kasirer1, Dan Turner, Leora Lerman
1The Pediatric Gastroenterology and Nutrition Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Summary
Duodenal fold scalloping on esophagogastroduodenoscopy (EGD) is a strong indicator for celiac disease (CD) in children. Observing scalloping during EGD significantly increases the likelihood of a CD diagnosis, aiding clinicians in identifying the condition.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Celiac Disease Diagnosis
Background:
- Scalloping of duodenal folds during esophagogastroduodenoscopy (EGD) is linked to various conditions, including celiac disease (CD).
- Understanding the frequency and diagnostic utility of scalloping in children is crucial for accurate celiac disease diagnosis.
Purpose of the Study:
- To determine the frequency of duodenal fold scalloping in pediatric patients undergoing EGD.
- To assess the significance of scalloping as a diagnostic marker for celiac disease in children.
- To evaluate the association of scalloping with histopathology and serology in pediatric celiac disease patients.
Main Methods:
- Retrospective analysis of 623 children (0-18 years) who underwent EGD over a 2.5-year period.
- Data collection included patient files, focusing on EGD findings, histopathology, and celiac serology.
- No selection bias was introduced in the consecutive cohort analysis.
Main Results:
- Scalloping was observed in 12% of pediatric EGDs, with a high specificity (99%) and positive predictive value (97%) for diagnosing CD.
- The prevalence of scalloping increased with the severity of Marsh classification in celiac disease patients (33% in Marsh 1 to 63% in Marsh 3c).
- Scalloping was significantly associated with higher median tissue transglutaminase levels in celiac disease patients.
Conclusions:
- Isolated duodenal fold scalloping during EGD strongly suggests celiac disease in pediatric patients.
- Attention to duodenal fold scalloping can serve as a valuable additional tool in the diagnostic process for celiac disease.
- This finding enhances the diagnostic accuracy of EGD for identifying celiac disease in children.
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