Boschee Erin D, Yap Jason Y K, Turner Justine M
Erin D Boschee, Department of Pediatrics, University of Alberta, Edmonton, Alberta T6G 2B7, Canada.
World J Gastroenterol. 2017 Jan 28;23(4):646-652. doi: 10.3748/wjg.v23.i4.646.
To determine the sensitivity of macroscopic appearance for predicting histological diagnosis at sites other than duodenum in pediatric celiac disease (CD).
Endoscopic and histologic findings in pediatric patients undergoing upper endoscopy for first-time diagnosis of CD at Stollery Children's Hospital from 2010-2012 were retrospectively reviewed.
Clinical charts from 140 patients were reviewed. Esophageal and gastric biopsies were taken in 54.3% and 77.9% of patients, respectively. Endoscopic appearance was normal in the esophagus and stomach in 75% and 86.2%. Endoscopic esophageal diagnoses were eosinophilic esophagitis (EE) (11.8%), esophagitis (7.9%), glycogenic acanthosis (1.3%) and non-specific abnormalities (3.9%). Endoscopic gastric diagnoses were gastritis (8.3%), pancreatic rest (0.9%), and non-specific abnormalities (4.6%). Histology was normal in 76.3% of esophageal and 87.2% of gastric specimens. Abnormal esophageal histology was EE (10.5%), esophagitis (10.5%), glycogenic acanthosis (1.3%) and non-specific (1.3%). Gastritis was reported in 12.8% of specimens. Sensitivity and specificity of normal endoscopy for predicting normal esophageal histology was 86.2% and 61.1%, and for normal gastric histology was 87.4% and 21.4%.
In the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during endoscopy for pediatric CD does not identify major pathologies. These findings have cost and time saving implications for clinical practice.
确定在小儿乳糜泻（CD）中，除十二指肠外其他部位的宏观表现对预测组织学诊断的敏感性。
回顾性分析2010年至2012年在斯托利儿童医院首次接受上消化道内镜检查以诊断CD的小儿患者的内镜和组织学检查结果。
对140例患者的临床病历进行了回顾。分别有54.3%和77.9%的患者进行了食管和胃活检。食管和胃的内镜表现正常的分别占75%和86.2%。内镜诊断的食管疾病为嗜酸性食管炎（EE）（11.8%）、食管炎（7.9%）、糖原棘皮症（1.3%）和非特异性异常（3.9%）。内镜诊断的胃部疾病为胃炎（8.3%）、胰腺异位（0.9%）和非特异性异常（4.6%）。76.3%的食管标本和87.2%的胃标本组织学正常。食管组织学异常为EE（10.5%）、食管炎（10.5%）、糖原棘皮症（1.3%）和非特异性（1.3%）。12.8%的标本报告有胃炎。内镜正常对预测食管组织学正常的敏感性和特异性分别为86.2%和61.1%，对预测胃组织学正常的敏感性和特异性分别为87.4%和21.4%。
在没有宏观异常的情况下，小儿CD内镜检查时常规进行食管和胃活检无法发现主要病变。这些发现对临床实践具有节省成本和时间的意义。
