CORRELATION BETWEEN ENDOSCOPIC AND HISTOLOGICAL DIAGNOSES OF DUODENAL ATROPHY

Aims:

Duodenal atrophy (DA) is a mandatory condition for the diagnosis of celiac disease. This study aimed to evaluate the correlation between endoscopic and histological findings of DA.

Methods:

We performed a retrospective review of all patients undergoing upper gastrointestinal endoscopy with duodenal biopsies between January 2010 and January 2016.. Patients with Crohn's disease or lymphoma were excluded.

Results:

457 patients were included: 302 women and 155 men (sex ratio = 0.51), the mean age was 50 years (3 – 88 years). The main indications for endoscopy with duodenal biopsies were iron deficiency anemia in 60% of cases and chronic diarrhea in 30% of cases. Endoscopically, the duodenal mucosa was normal in 342 patients (74.8%). there was a decrease in the height of the duodenal folds in 60 patients, duodenal atrophy in 30 patients, a crenellated appearance in 13 patients and an appearance in mosaic in 12 patients. Histologically: Of the 342 patients with normal duodenal mucosa, 48 patients (14%) had a histological change: villous atrophy in 19 patients and focal elevation of intraepithelial lymphocytes in 29 patients. Of the 60 patients with reduced duodenal fold height at endoscopy, only 18 patients (31.6%) had a histological change. Of the 30 patients with endoscopic duodenal atrophy, 22 patients (73.3%) had villous atrophy on histology. All patients with a crenellaed appearence of the duodenum had histological changes. The diagnosis of celiac disease was retained in 52 patients (11.3%).

Conclusions:

The sensitivity of endoscopic DA diagnosis is low, the mosaic and crenellated appearance of the duodenum are suggestive, confirmation by histology is necessary.