Reyes Hugo, Niveloni Sonia, Moreno María L, Vázquez Horacio, Jer Hwang Hui, Argonz Julio, Sugai Emilia, Mazure Roberto, Smecuol Edgardo, Crivelli Adriana, La Motta Gisella, Caniggia María E, Gómez Juan C, Chopita Néstor, Kogan Zulema, Cabanne Ana, Mauriño Eduardo, Bai Julio C
Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Ciudad Autónoma de Buenos Aires, Argentina.
Acta Gastroenterol Latinoam. 2008 Sep;38(3):178-86.
BACKGROUND/OBJECTIVES: the usefulness of duodenoscopic markers for predicting celiac disease (CD) has been questioned. We assessed the diagnostic efficacy of endoscopic markers of mucosal atrophy in individuals with different pretest probability of CD.
we prospectively performed endoscopic intestinal biopsies and CD-related serology tests in 661 individuals, including 143 consecutive patients attending a malabsorption clinic (high pretest probability) and 518 subjects randomly selected fom those undergoing routine endoscopy because of upper GI symptoms (low pretest probability). Duodenoscopic markers reported were: mosaic pattern, scalloped folds, and reduction in number or loss of Kerkring's folds.
sixty-three (44.1%) and 18 (3.5%) patients were diagnosed with CD in the high and low risk groups, respectively Among high pretest subjects, the presence of any marker had very high sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the identification of CD (92.1%, 93.8%, 92.1%, 93.8% and 93.0%, respectively). The performance of these parameters for the presence of any marker in the low pretest population were 61.1%, 96.8%, 40.7%, 98.6% and 95.6%, respectively. Sensitivity (p < 0.004) and positive predictive value (p < 0.0001) of markers were significantly higher for the high risk patients. The identification of a reduction in number or loss of Kerkring'sfolds was not a reliable finding unless other signs were also present.
we confirm that endoscopic markers are useful in predicting CD in different clinical scenarios. The high negative predictive value in the low probability group suggests that intestinal biopsy is not required if endoscopic markers are absent.
背景/目的：十二指肠镜标记物预测乳糜泻（CD）的效用受到质疑。我们评估了黏膜萎缩内镜标记物在不同CD预测试验概率个体中的诊断效能。
我们前瞻性地对661名个体进行了内镜下肠道活检和CD相关血清学检测，其中包括143名连续就诊于吸收不良门诊的患者（预测试验概率高）和518名因上消化道症状接受常规内镜检查而随机选取的受试者（预测试验概率低）。报告的十二指肠镜标记物有：马赛克图案、扇形皱襞以及克尔克林皱襞数量减少或消失。
高风险组和低风险组分别有63名（44.1%）和18名（3.5%）患者被诊断为CD。在预测试验概率高的受试者中，任何一种标记物的存在对于CD的识别具有非常高的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性（分别为92.1%、93.8%、92.1%、93.8%和93.0%）。在预测试验概率低的人群中，这些参数对于任何一种标记物存在情况的表现分别为61.1%、96.8%、40.7%、98.6%和95.6%。标记物的敏感性（p < 0.004）和阳性预测值（p < 0.0001）在高风险患者中显著更高。除非同时存在其他体征，否则克尔克林皱襞数量减少或消失的识别并非可靠发现。
我们证实内镜标记物在不同临床情况下对预测CD有用。低概率组中的高阴性预测值表明，如果没有内镜标记物，则无需进行肠道活检。
