GASTROENTEROLOGY ARTICLE OF THE WEEK
January 23, 2003
Olds G, McLoughlin R, O’Morian C, Sivak MV. Celiac disease for the endoscopist. Gstrointest Endosc 2002;56:407-415.
1. Endoscopic diagnosis of celiac sprue
a. proximal duodenal biopsies are as good as jejunal biopsies to establish the diagnosis
b. jumbo biopsy forceps should always be used
c. a minimum of 4 specimens should be obtained and oriented in filter paper
d. when filter paper is not used, more samples should be obtained.
2. Celiac sprue
a. prevalence in western countries is about 1:250-300
b. over 50% have no symptoms
c. diarrhea is the most common presenting symptom
d. this diagnosis should not be considered in patients presenting with constipation
e. recurrent aphthous ulcers should raise the possibility of Crohn’s disease
True or False
3. Dermatitis herpetiformis is present in 60% of celiac sprue patients.
4. Small bowel biopsies obtained during endoscopic examination are inferior to capsule biopsies in establishing the diagnosis of celiac sprue.
5. Endoscopic signs of celiac sprue are highly specific for not very sensitive for the diagnosis.
6. Endoscopic findings suggestive of sprue
a. no more than 3 folds in the second portion of the duodenum when viewed with full air insufflation
b. scalloped appearance of duodenal folds
c. mucosal grooves between the folds
d. scalloping of the duodenal folds is pathognomonic for celiac sprue
e. mosaic mucosal pattern recognized after spraying methylene blue