Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.646
Peer-review started: September 18, 2016
First decision: October 28, 2016
Revised: November 10, 2016
Accepted: December 16, 2016
Article in press: December 19, 2016
Published online: January 28, 2017
Processing time: 125 Days and 22.9 Hours
To determine the sensitivity of macroscopic appearance for predicting histological diagnosis at sites other than duodenum in pediatric celiac disease (CD).
Endoscopic and histologic findings in pediatric patients undergoing upper endoscopy for first-time diagnosis of CD at Stollery Children’s Hospital from 2010-2012 were retrospectively reviewed.
Clinical charts from 140 patients were reviewed. Esophageal and gastric biopsies were taken in 54.3% and 77.9% of patients, respectively. Endoscopic appearance was normal in the esophagus and stomach in 75% and 86.2%. Endoscopic esophageal diagnoses were eosinophilic esophagitis (EE) (11.8%), esophagitis (7.9%), glycogenic acanthosis (1.3%) and non-specific abnormalities (3.9%). Endoscopic gastric diagnoses were gastritis (8.3%), pancreatic rest (0.9%), and non-specific abnormalities (4.6%). Histology was normal in 76.3% of esophageal and 87.2% of gastric specimens. Abnormal esophageal histology was EE (10.5%), esophagitis (10.5%), glycogenic acanthosis (1.3%) and non-specific (1.3%). Gastritis was reported in 12.8% of specimens. Sensitivity and specificity of normal endoscopy for predicting normal esophageal histology was 86.2% and 61.1%, and for normal gastric histology was 87.4% and 21.4%.
In the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during endoscopy for pediatric CD does not identify major pathologies. These findings have cost and time saving implications for clinical practice.
Core tip: We performed a retrospective chart review of esophageal and gastric endoscopic and histologic findings in pediatric patients diagnosed with celiac disease (CD). Our findings suggest that, in the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during upper endoscopy for pediatric CD does not identify major pathologies. The implication of limiting biopsies to the duodenum and duodenal bulb may be both cost and time-saving. Overall, the results of this study may have the ability to promote standardization and optimal resource allocation for routine diagnostic practices for pediatric CD.