Small Bowel Section, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina.
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova 35124, Italy.
World J Gastroenterol. 2022 Nov 21;28(43):6157-6167. doi: 10.3748/wjg.v28.i43.6157.
BACKGROUND: Gastroduodenal endoscopy and biopsy following positive specific serology is considered the gold standard to diagnose celiac disease (CeD) in adults. Whether upper endoscopy helps detect comorbid conditions is unknown. AIM: To investigate the prevalence of non-celiac endoscopic findings in patients in whom endoscopy was performed to confirm CeD diagnosis. METHODS: This is an observational, descriptive, multicenter, retrospective study that reports endoscopic findings obtained in adult patients enrolled in local registries from four tertiary centers. We collected data reported on first endoscopy, indicated for investigation of CeD. Diagnosis of CeD was performed by histology (≥ Marsh 2 type mucosal damage) and specific serology. Two European and one North American center included biopsy-confirmed CeD following positive serology. A fourth center (South America) included symptomatic patients undergoing endoscopy, irrespective of CeD serology. The latter cohort included a non-CeD control group. RESULTS: A total of 1328 patients (80% female; 35 years median age) were enrolled, of whom 95.6% had positive specific serology. In 135 patients, endoscopy revealed 163 abnormalities unrelated to CeD (prevalence: 10.1%). Erosive reflux esophagitis (6.4%), gastric erosions (2.0%), and suspicion of esophageal metaplasia (1.2%) were the most common findings. Biopsy-confirmed Barrett's esophagus was infrequent (0.2%). No endoscopic cancer was detected. Older patients (≥ 51 years of age) had a higher prevalence of endoscopic findings than those ≤ 50 ( < 0.01). Within the South American cohort, CeD was associated with a lower rate (8.2%) of comorbid endoscopic findings compared with controls (29.1%; < 0.001). In the adjusted multivariate analysis of this cohort, having CeD was associated with a 72% reduction in the risk of any endoscopic abnormality < 0.0001), and having alarm symptoms was associated with a 37% reduction in the risk of finding at least one endoscopic lesion ( < 0.02). CONCLUSION: In this large multicenter study, young adults with positive CeD serology had few comorbid endoscopic findings. Although patients over 51 years had a high prevalence of non-CeD gastroduodenal mucosal damage, no malignancy or premalignant lesions were found.
背景：胃十二指肠内镜检查和活检结合阳性特异性血清学检查被认为是诊断成人乳糜泻（CeD）的金标准。然而，内镜检查是否有助于发现合并症尚不清楚。
目的：调查在进行内镜检查以确认 CeD 诊断的患者中，非乳糜泻内镜检查结果的患病率。
方法：这是一项观察性、描述性、多中心、回顾性研究，报告了来自四个三级中心的当地登记处招募的成年患者的内镜检查结果。我们收集了首次内镜检查的数据，该检查是为了调查 CeD 而进行的。CeD 的诊断通过组织学（≥Marsh 2 型黏膜损伤）和特异性血清学进行。两个欧洲和一个北美中心纳入了阳性血清学后活检证实的 CeD。第四个中心（南美洲）纳入了接受内镜检查的有症状患者，不论 CeD 血清学如何。后者队列包括非 CeD 对照组。
结果：共纳入 1328 名患者（80%为女性；中位年龄 35 岁），其中 95.6%的患者特异性血清学阳性。在 135 名患者中，内镜检查显示与 CeD 无关的 163 种异常（患病率：10.1%）。糜烂性反流性食管炎（6.4%）、胃糜烂（2.0%）和食管化生可疑（1.2%）是最常见的发现。活检证实的 Barrett 食管很少见（0.2%）。未发现内镜下癌症。≥51 岁的患者比≤50 岁的患者更常见内镜检查结果（<0.01）。在南美洲队列中，与对照组（29.1%；<0.001）相比，CeD 患者合并内镜检查结果的发生率较低（8.2%）。在该队列的调整多变量分析中，患有 CeD 与任何内镜异常的风险降低 72%相关（<0.0001），而有报警症状与发现至少一种内镜病变的风险降低 37%相关（<0.02）。
结论：在这项大型多中心研究中，阳性 CeD 血清学的年轻成年人合并的内镜检查结果较少。尽管≥51 岁的患者胃十二指肠黏膜损伤的非乳糜泻患病率较高，但未发现恶性或癌前病变。
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