Brocchi E, Corazza G R, Caletti G, Treggiari E A, Barbara L, Gasbarrini G
I Patologia Medica, Policlinico S. Orsola, Università di Bologna, Italy.
N Engl J Med. 1988 Sep 22;319(12):741-4. doi: 10.1056/NEJM198809223191202.
Among 873 patients undergoing upper gastrointestinal endoscopy for various reasons over a two-year period, four had a loss of Kerckring's folds in the descending duodenum. Endoscopic duodenal biopsy in all four patients revealed subtotal villous atrophy due to celiac disease. We undertook a prospective study to evaluate the extent to which this finding predicted celiac disease in 65 consecutive patients referred for intestinal biopsy. Duodenal folds were absent or markedly decreased in 15 of 17 patients with subtotal villous atrophy and in 8 of 48 patients with partial villous atrophy or normal duodenal mucosa, giving a sensitivity of 88 percent and a specificity of 83 percent for this endoscopic finding with respect to celiac disease. We recommend that all patients undergoing upper gastrointestinal endoscopy be examined for the loss or reduction of duodenal folds and, should this be found, that the examination include duodenal biopsy. The value of this procedure as an aid in the diagnosis of celiac disease should be particularly great in patients with minimal, transient, or unrelated symptoms.
在两年时间里，因各种原因接受上消化道内镜检查的873例患者中，有4例十二指肠降部的环形皱襞消失。对这4例患者进行的内镜下十二指肠活检显示，由于乳糜泻导致绒毛广泛萎缩。我们进行了一项前瞻性研究，以评估这一发现对65例连续转诊进行肠道活检的患者中乳糜泻的预测程度。在17例绒毛广泛萎缩的患者中，有15例十二指肠皱襞缺失或明显减少；在48例部分绒毛萎缩或十二指肠黏膜正常的患者中，有8例出现这种情况。就乳糜泻而言，这一内镜检查结果的敏感性为88%，特异性为83%。我们建议，所有接受上消化道内镜检查的患者都应检查十二指肠皱襞是否缺失或减少，如果发现这种情况，检查应包括十二指肠活检。在症状轻微、短暂或无关的患者中，这一检查方法对乳糜泻诊断的辅助价值应该特别大。
