Robson Kathryn, Alizart Michelle, Martin Jarad, Nagel Robyn
Toowoomba Gastroenterology Clinic, Medici Medical Centre, Toowoomba, Queensland, Australia.
Radiation Oncology Queensland, St Andrew's Hospital, Toowoomba, Queensland, Australia.
PLoS One. 2014 Mar 4;9(3):e90552. doi: 10.1371/journal.pone.0090552. eCollection 2014.
Two out of three patients with Coeliac Disease (CD) in Australia are undiagnosed. This prospective clinical audit aimed to determine how many CD patients would be undiagnosed if duodenal biopsy had only been performed if the mucosa looked abnormal or the patient presented with typical CD symptoms.
All eligible patients presenting for upper gastrointestinal endoscopy (OGD) in a regional center from 2004-2009 underwent prospective analysis of presenting symptoms and duodenal biopsy. Clinical presentations were defined as either Major (diarrhea, weight loss, iron deficiency, CD family history or positive celiac antibodies- Ab) or Minor Clinical Indicators (CI) to duodenal biopsy (atypical symptoms). Newly diagnosed CD patients had follow up celiac antibody testing.
Thirty-five (1.4%) new cases of CD were identified in the 2,559 patients biopsied at upper endoscopy. Almost a quarter (23%) of cases presented with atypical symptoms. There was an inverse relationship between presentation with Major CI's and increasing age (<16, 16-59 and >60: 100%, 81% and 50% respectively, p = 0.03); 28% of newly diagnosed CD patients were aged over 60 years. Endoscopic appearance was a useful diagnostic tool in only 51% (18/35) of CD patients. Coeliac antibodies were positive in 34/35 CD patients (sensitivity 97%).
Almost one quarter of new cases of CD presented with atypical symptoms and half of the new cases had unremarkable duodenal mucosa. At least 10% of new cases of celiac disease are likely to be undiagnosed at routine upper endoscopy, particularly patients over 60 years who more commonly present atypically. All new CD patients could be identified in this study by performing pre-operative celiac antibody testing on all patients presenting for OGD and proceeding to biopsy only positive antibody patients and those presenting with either Major CI or abnormal duodenal mucosa for an estimated cost of AUS$4,629 and AUS$3,710 respectively.
在澳大利亚，三分之二的乳糜泻（CD）患者未被诊断出来。这项前瞻性临床审计旨在确定，如果仅在十二指肠黏膜看起来异常或患者出现典型CD症状时才进行十二指肠活检，会有多少CD患者未被诊断出来。
2004年至2009年期间，在一个地区中心接受上消化道内镜检查（OGD）的所有符合条件的患者，均对其症状表现和十二指肠活检进行了前瞻性分析。临床表现被定义为十二指肠活检的主要指标（腹泻、体重减轻、缺铁、CD家族史或乳糜泻抗体阳性 - Ab）或次要临床指标（CI）（非典型症状）。新诊断出的CD患者进行了后续的乳糜泻抗体检测。
在上消化道内镜检查活检的2559名患者中，确诊了35例（1.4%）新的CD病例。近四分之一（23%）的病例表现为非典型症状。主要临床指标的出现与年龄增长呈负相关（<16岁、16 - 59岁和>60岁：分别为100%、81%和50%，p = 0.03）；28%新诊断出的CD患者年龄超过60岁。内镜表现仅在51%（18/35）的CD患者中是有用的诊断工具。35例CD患者中有34例乳糜泻抗体呈阳性（敏感性97%）。
近四分之一的新CD病例表现为非典型症状，且一半的新病例十二指肠黏膜无明显异常。在常规上消化道内镜检查中，至少10%的新乳糜泻病例可能未被诊断出来，特别是60岁以上的患者，他们更常表现为非典型症状。在本研究中，通过对所有接受OGD的患者进行术前乳糜泻抗体检测，并仅对抗体阳性患者以及出现主要临床指标或十二指肠黏膜异常的患者进行活检，所有新的CD患者都可以被识别出来，估计费用分别为4629澳元和3710澳元。
