Ludvigsson Jonas F, Brandt Lena, Montgomery Scott M, Granath Fredrik, Ekbom Anders
Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.
BMC Gastroenterol. 2009 Mar 11;9:19. doi: 10.1186/1471-230X-9-19.
Small intestinal biopsy with villous atrophy (VA) is the gold standard for the diagnosis of celiac disease (CD). We validated VA (Marsh 3) and small intestinal inflammation without VA (Marsh 1+2) in Swedish regional biopsy registers.
All pathology departments in Sweden (n = 28) were searched to identify individuals with VA or duodenal/jejunal inflammation. The validation consisted of blinded examination of biopsy samples, manual review of biopsy reports, web surveys, and patient chart reviews of 121 individuals with VA and 39 with inflammation.
We identified 29,148 individuals with VA and 13,446 individuals with inflammation. In a blinded examination, Swedish pathologists correctly classified 90% of biopsies with VA. Manual screening of 1,534 biopsy reports (performed by co-author JFL and a research assistant) found that comorbidity other than CD was rare. IBD was the most common comorbidity and occurred in 0.3% of biopsies with VA (1.6% in inflammation). Among 114 patients with VA and available data, 108 (95%) had a clinical diagnosis of CD. 79% of the validated individuals with VA and 64% of those with inflammation had documented gastrointestinal symptoms prior to biopsy. 88% of the validated individuals with VA had positive CD serology before their first biopsy. 172/180 (96%) of Swedish gastroenterologists and 68/68 (100%) of pediatricians perform a small intestinal biopsy in at least 9 out of 10 individuals prior to diagnosis of CD.
Regional biopsy data are feasible to identify individuals with CD and small-intestinal inflammation. The specificity of CD is high in villous atrophy.
伴有绒毛萎缩（VA）的小肠活检是乳糜泻（CD）诊断的金标准。我们在瑞典区域活检登记处验证了VA（马什3级）和无VA的小肠炎症（马什1 + 2级）。
检索瑞典所有28个病理科，以确定患有VA或十二指肠/空肠炎症的个体。验证包括对活检样本进行盲法检查、人工查阅活检报告、网络调查以及对121例患有VA的个体和39例患有炎症的个体进行病历审查。
我们确定了29148例患有VA的个体和13446例患有炎症的个体。在盲法检查中，瑞典病理学家正确分类了90%的伴有VA的活检样本。对1534份活检报告进行人工筛查（由共同作者JFL和一名研究助理进行）发现，除CD外的合并症很少见。炎症性肠病是最常见的合并症，在伴有VA的活检样本中占0.3%（在炎症样本中占1.6%）。在114例患有VA且有可用数据的患者中，108例（95%）有CD的临床诊断。在经验证的患有VA的个体中，79%以及患有炎症的个体中64%在活检前有记录在案的胃肠道症状。在经验证的患有VA的个体中，88%在首次活检前CD血清学呈阳性。172/180（96%）的瑞典胃肠病学家和68/68（100%）的儿科医生在诊断CD之前，至少对十分之九的个体进行小肠活检。
区域活检数据对于识别患有CD和小肠炎症的个体是可行的。绒毛萎缩时CD的特异性很高。
