CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(12): E1220-E1228
DOI: 10.1055/s-0043-120522
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Factors associated with number of duodenal samples obtained in suspected celiac disease

Leonid Shamban
1   Gastroenterology, Genesys Regional Medical Center, Grand Blanc, Michigan, United States
,
Serge Sorser
2   Gastroenterology, Providence-Providence Park Hospital, Novi, Michigan, United States
,
Stan Naydin
3   Internal Medicine, Drexel University, Philadelphia, Pennsylvania, United States
,
Benjamin Lebwohl
4   Clinical Medicine, Columbia University, New York, New York, United States
,
Mousa Shukr
5   Internal Medicine, Providence-Providence Park Hospital, Southfield, Michigan, United States
,
Charlotte Wiemann
5   Internal Medicine, Providence-Providence Park Hospital, Southfield, Michigan, United States
,
Daniel Yevsyukov
6   Division of Solid Organ Transplant, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, United States
,
Michael H. Piper
7   Gastroenterology, Providence-Providence Park, Southfield, Michigan, United States
,
Bradley Warren
7   Gastroenterology, Providence-Providence Park, Southfield, Michigan, United States
,
Peter H. R. Green
8   Clinical Medicine, Columbia University, New York, New York, United States
› Author Affiliations
Further Information

Publication History

submitted 30 December 2016

accepted after revision 26 June 2017

Publication Date:
06 December 2017 (online)

Abstract

Background and study aims Many people with celiac disease are undiagnosed and there is evidence that insufficient duodenal samples may contribute to underdiagnosis. The aims of this study were to investigate whether more samples leads to a greater likelihood of a diagnosis of celiac disease and to elucidate factors that influence the number of samples collected.

Patients and methods We identified patients from two community hospitals who were undergoing duodenal biopsy for indications (as identified by International Classification of Diseases code) compatible with possible celiac disease. Three cohorts were evaluated: no celiac disease (NCD, normal villi), celiac disease (villous atrophy, Marsh score 3), and possible celiac disease (PCD, Marsh score < 3). Endoscopic features, indication, setting, trainee presence, and patient demographic details were evaluated for their role in sample collection.

Results 5997 patients met the inclusion criteria. Patients with a final diagnosis of celiac disease had a median of 4 specimens collected. The percentage of patients diagnosed with celiac disease with one sample was 0.3 % compared with 12.8 % of those with six samples (P = 0.001). Patient factors that positively correlated with the number of samples collected were endoscopic features, demographic details, and indication (P = 0.001). Endoscopist factors that positively correlated with the number of samples collected were absence of a trainee, pediatric gastroenterologist, and outpatient setting (P < 0.001).

Conclusions Histological diagnosis of celiac disease significantly increased with six samples. Multiple factors influenced whether adequate biopsies were taken. Adherence to guidelines may increase the diagnosis rate of celiac disease.

 
  • References

  • 1 Lebwohl B, Bhagat G, Markoff S. et al. Prior endoscopy in patients with newly diagnosed celiac disease: a missed opportunity?. Dig Dis Sci 2013; 58: 1293-1298
  • 2 Brown IS, Smith J, Rosty C. Gastrointestinal pathology in celiac disease: a case series of 150 consecutive newly diagnosed patients. Am J Clin Pathol 2012; 138: 42-49
  • 3 Rubio-tapia A, Hill ID, Kelly CP. et al. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 2013; 108: 656-676
  • 4 Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology 2006; 131: 1981-2002
  • 5 Kurien M, Evans KE, Hopper AD. et al. Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?. Gastrointest Endosc 2012; 75: 1190-1196
  • 6 Pinto Sánchez MI, Smecuol E, Vázquez H. et al. Very high rate of misdiagnosis of celiac disease in clinical practice. Acta Gastroenterol Latinoam 2009; 39: 250-253
  • 7 Arguelles-grande C, Tennyson CA, Lewis SK. et al. Variability in small bowel histopathology reporting between different pathology practice settings: impact on the diagnosis of coeliac disease. J Clin Pathol 2012; 65: 242-247
  • 8 Green PH, Murray JA. Routine duodenal biopsies to exclude celiac disease?. Gastrointest Endosc 2003; 58: 92-95
  • 9 Cammarota G, Ianiro G, Sparano L. et al. Image-enhanced endoscopy with I-scan technology for the evaluation of duodenal villous patterns. Dig Dis Sci 2013; 58: 1287-1292
  • 10 Rostami K, Kasturi R, Villanacci V. et al. Challenges in endoscopy and histological diagnosis of celiac disease. Endoscopy 2011; 43: 375
  • 11 Lee SK, Green PH. Endoscopy in celiac disease. Curr Opin Gastroenterol 2005; 21: 589-594
  • 12 Antonioli DA. Celiac disease: a progress report. Mod Pathol 2003; 16: 342-346
  • 13 Dickson BC, Streutker CJ, Chetty R. Coeliac disease: an update for pathologists. J Clin Pathol 2006; 59: 1008-1016
  • 14 Lebwohl B, Kapel RC, Neugut AI. et al. Adherence to biopsy guidelines increases celiac disease diagnosis. Gastrointest Endosc 2011; 74: 103-109
  • 15 Rostami-Nejad M, Villanacci V, Hogg-kollars S. et al. Endoscopic and histological pitfalls in the diagnosis of celiac disease: a multicentre study assessing the current practice. Rev Esp Enferm Dig 2013; 105: 326-333
  • 16 Dickey W, Hughes D. Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy. Am J Gastroenterol 2001; 96: 2126-2128
  • 17 Ianiro G, Gasbarrini A, Cammarota G. Endoscopic tools for the diagnosis and evaluation of celiac disease. World J Gastroenterol 2013; 19: 8562-8570
  • 18 Vilppula A, Collin P, Mäki M. et al. Undetected coeliac disease in the elderly: a biopsy-proven population-based study. Dig Liver Dis 2008; 40: 809-813
  • 19 Lebwohl B, Tennyson CA, Holub JL. et al. Sex and racial disparities in duodenal biopsy to evaluate for celiac disease. Gastrointest Endosc 2012; 76: 779-785
  • 20 Brar P, Lee AR, Lewis SK. et al. Celiac disease in African-Americans. Dig Dis Sci 2006; 51: 1012-1015
  • 21 Murray JA, Van Dyke C, Plevak MF. et al. Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001. Clin Gastroenterol Hepatol 2003; 1: 19-27
  • 22 Reilly NR, Green PH. Epidemiology and clinical presentations of celiac disease. Semin Immunopathol 2012; 34: 473-478
  • 23 Bao F, Green PH, Bhagat G. An update on celiac disease histopathology and the road ahead. Arch Pathol Lab Med 2012; 136: 735-745
  • 24 Kav T, Sivri B. Is enteroscopy necessary for diagnosis of celiac disease?. World J Gastroenterol 2012; 18: 4095-4101
  • 25 Buchner AM, Shahid MW, Heckman MG. et al. Trainee participation is associated with increased small adenoma detection. Gastrointest Endosc 2011; 73: 1223-1231
  • 26 Gonzalez S, Gupta A, Cheng J. et al. Prospective study of the role of duodenal bulb biopsies in the diagnosis of celiac disease. Gastrointest Endosc 2010; 72: 758-765
  • 27 Evans KE, Aziz I, Cross SS. et al. A prospective study of duodenal bulb biopsy in newly diagnosed and established adult celiac disease. Am J Gastroenterol 2011; 106: 1837-1842
  • 28 Collin P, Kaukinen K, Vogelsang H. et al. Antiendomysial and antihuman recombinant tissue transglutaminase antibodies in the diagnosis of coeliac disease: a biopsy-proven European multicentre study. Eur J Gastroenterol Hepatol 2005; 17: 85-91
  • 29 Latorre M, Lagana SM, Freedberg DE. et al. Endoscopic biopsy technique in the diagnosis of celiac disease: one bite or two?. Gastrointest Endosc 2015; 81: 1228-1233
  • 30 Ciacci C, De florio M. Evaluation of an instrument for the surveillance of adult gluten intolerance diagnosis: Report of the first year of activity of the Campania Celiac Network for Adult Celiac Disease. Dig Liver Dis 2007; 39: 703-704
  • 31 Ravelli A, Villanacci V. Tricks of the trade: How to avoid histological pitfalls in celiac disease. Pathol Res Pract 2012; 208: 197-202