Published online Nov 21, 2022. doi: 10.3748/wjg.v28.i43.6157
Peer-review started: August 24, 2022
First decision: September 8, 2022
Revised: September 22, 2022
Accepted: November 7, 2022
Article in press: November 7, 2022
Published online: November 21, 2022
Processing time: 83 Days and 19.2 Hours
Gastroduodenal endoscopy and biopsy following positive specific serology is considered the gold standard to diagnose celiac disease (CeD) in adults. Whether upper endoscopy helps detect comorbid conditions is unknown.
To investigate the prevalence of non-celiac endoscopic findings in patients in whom endoscopy was performed to confirm CeD diagnosis.
This is an observational, descriptive, multicenter, retrospective study that reports endoscopic findings obtained in adult patients enrolled in local registries from four tertiary centers. We collected data reported on first endoscopy, indicated for investigation of CeD. Diagnosis of CeD was performed by histology (≥ Marsh 2 type mucosal damage) and specific serology. Two European and one North American center included biopsy-confirmed CeD following positive serology. A fourth center (South America) included symptomatic patients undergoing endoscopy, irrespective of CeD serology. The latter cohort included a non-CeD control group.
A total of 1328 patients (80% female; 35 years median age) were enrolled, of whom 95.6% had positive specific serology. In 135 patients, endoscopy revealed 163 abnormalities unrelated to CeD (prevalence: 10.1%). Erosive reflux esophagitis (6.4%), gastric erosions (2.0%), and suspicion of esophageal metaplasia (1.2%) were the most common findings. Biopsy-confirmed Barrett’s esophagus was infrequent (0.2%). No endoscopic cancer was detected. Older patients (≥ 51 years of age) had a higher prevalence of endoscopic findings than those ≤ 50 (P < 0.01). Within the South American cohort, CeD was associated with a lower rate (8.2%) of comorbid endoscopic findings compared with controls (29.1%; P < 0.001). In the adjusted multivariate analysis of this cohort, having CeD was associated with a 72% reduction in the risk of any endoscopic abnormality (P < 0.0001), and having alarm symptoms was associated with a 37% reduction in the risk of finding at least one endoscopic lesion (P < 0.02).
In this large multicenter study, young adults with positive CeD serology had few comorbid endoscopic findings. Although patients over 51 years had a high prevalence of non-CeD gastroduodenal mucosal damage, no malignancy or premalignant lesions were found.
Core Tip: We offer novel data on the prevalence of non-celiac endoscopic findings at the time of endoscopy performed to confirm celiac disease (CeD) diagnosis. Based on the very high performance of specific serology tests, the diagnosis of CeD without duodenal biopsy has been proposed in recent years. However, some guidelines do not recommend avoiding endoscopy because relevant comorbid diagnosis can be missed. Our results found that comorbid upper gastrointestinal endoscopic pathology is uncommon in patients with positive CeD serology at the time of diagnostic endoscopy suggesting that a non-biopsy strategy is unlikely to clinically miss significant concomitant endoscopic findings unrelated to CeD.