CELIAC DISEASE AND DOUBLE-BALLOON ENTEROSCOPY: WHAT WE NEED FOR?

Aims:

Indications to double-balloon enteroscopy (DBE) are currently not standardized in celiac disease (CD). We aimed to investigate the role and value of this modality in the diagnosis and treatment of CD and resistant celiac disease (RCD) prospectively.

Methods:

Appointed to Kocaeli University between June 2017 and May 2018, in total 26 of patients who have been examined for celiac disease and have not been diagnosed despite having a duodenal biopsy and 6 patients with RCD included in the study. All patients underwent oral DBE. Control biopsies were obtained from duodenum, jejenum and ileum. Biopsy specimens were examined according to Modified Marsh Scoring (MMS). Contribution of biopsies taken from the duodenum, jejenum and ileum via gastroscopy and DBE to the management of RCD and to the diagnosis of CD were compared.

Results:

When biopsy specimens were evaluated in terms of intraepithelial T lymphocyte count, no significant difference was detected between the two groups (p = 0,868). In the evaluation performed with the MMS in terms of the diagnosis of CD, the results were significantly in favor of duodenal samples (0,002). Although there were no statistically significant differences between the first screening samples from duodenum and the samples taken with DBE from duodenum, jejunum and ileum it was seen that the duodenal specimens were histopathologically more positive comparison to the first duodenal sampling taken with gastroscopy (6/24). Four of these patients were diagnosed with CD. One of six RCD patients has stricturan Crohn disease in ileum and the other one has GİST in jejunoileal region.

Conclusions:

It seems to be an appropriate strategy to repeat the serological and histopathological examinations if complaints persist in patients with negative initial investigations for celiac disease. In individuals with RCD, DBE gives hope as a very important modality in medical management and treatment.