Behforouz Amir, Esmaeelzadeh Abbas, Mozaffari Homan Mosanan, Mokhtarifar Ali, Faravani Elham, Amoueian Sakineh, Khooei Alireza, Jarahi Lida, Goshayeshi Ladan
Radiology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Gastroenterology Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Gastroenterol Res Pract. 2020 Dec 22;2020:6664741. doi: 10.1155/2020/6664741. eCollection 2020.
Celiac disease (CD) is a chronic and common cause of dyspepsia with a rising prevalence worldwide. This study is aimed at investigating the prevalence of CD in dyspeptic patients based on serology and biopsy, determining the associated factors, and assessing the necessity of regular duodenal biopsies from normal mucosa in diagnosis of CD among dyspeptic patients.
This cross-sectional study was performed on 530 adult dyspeptic patients who underwent gastroduodenoscopy in Imam Reza hospital, Mashhad, during 2016-2018. Demographic characteristics, clinical data, and laboratory analyses were extracted from hospital records. CD was diagnosed based on intestinal biopsy and serum antitissue transglutaminase (anti-TTG) levels. Mucosal lesions were classified according to the modified Marsh classification. Data were analyzed in SPSS with < 0.05 being considered significant.
Overall, 163 males (30.8%) and 367 females (69.2%) with an average age of 46.38 ± 15.54 years were studied. High anti-TTG levels were seen in 36 (6.8%) patients, and duodenal pathologies were seen in 23 (4.5%) patients. Fifteen (2.8%) were diagnosed with CD based on both serology and biopsy. Bloating was the most common type of dyspepsia in CD patients (7, 46.7%), followed by epigastric pain (6, 40%), and postprandial fullness (2, 13.3%). Two CD patients (13.3%) reported a positive family history for CD. Logistic regression model showed that iron deficiency anemia (IDA), anti-TTG level, and Helicobacter pylori infection were predictors of histological changes of CD, whereas IDA was the only independent predictor of CD in dyspeptic patients (OR = 17.65, 95%CI = 1.53-202.52, and = 0.021).
CD is prevalent in dyspeptic patients, but routine biopsy from normal-appearing duodenal mucosa is not recommended for all patients. Serological studies, complete history, and careful endoscopic evaluation may provide better cost-effective clinical solutions to improve the diagnostic yield of celiac disease in dyspeptic patients.
乳糜泻（CD）是消化不良的一种常见慢性病因，在全球范围内患病率呈上升趋势。本研究旨在基于血清学和活检调查消化不良患者中CD的患病率，确定相关因素，并评估在消化不良患者诊断CD时对正常黏膜进行常规十二指肠活检的必要性。
本横断面研究对2016年至2018年期间在马什哈德伊玛目礼萨医院接受胃十二指肠镜检查的530例成年消化不良患者进行。从医院记录中提取人口统计学特征、临床数据和实验室分析结果。根据肠道活检和血清抗组织转谷氨酰胺酶（抗TTG）水平诊断CD。根据改良的马什分类法对黏膜病变进行分类。在SPSS中进行数据分析，P<0.05被认为具有统计学意义。
共研究了163例男性（30.8%）和367例女性（69.2%），平均年龄为46.38±15.54岁。36例（6.8%）患者抗TTG水平升高，23例（4.5%）患者存在十二指肠病变。15例（2.8%）患者根据血清学和活检被诊断为CD。腹胀是CD患者中最常见的消化不良类型（7例，46.7%），其次是上腹部疼痛（6例，40%）和餐后饱胀感（2例，13.3%）。2例CD患者（13.3%）报告有CD家族史阳性。逻辑回归模型显示，缺铁性贫血（IDA）、抗TTG水平和幽门螺杆菌感染是CD组织学改变的预测因素，而IDA是消化不良患者中CD的唯一独立预测因素（OR=17.65，95%CI=1.53-202.52，P=0.021）。
CD在消化不良患者中普遍存在，但不建议对所有患者对外观正常的十二指肠黏膜进行常规活检。血清学研究、完整病史和仔细的内镜评估可能提供更好的成本效益高的临床解决方案，以提高消化不良患者乳糜泻的诊断率。
