A standard number of biopsies were taken when any endoscopic abnormality was detected ( e.g., endoscopic evidence of esophageal metaplasia). Duodenal biopsies were sent to each institution’s experienced pathologist. Endoscopic reports were generated using a standard format, and the data were entered into a common database. In all CeD centers, experienced gastroenterologists performed upper gastrointestinal endoscopies and obtained duodenal biopsies per shared standard of care protocols. Patients with at least one significant endoscopic abnormality In Italy, Ethical Committee review was not required for retrospective studies while patient data remained anonymously coded.ĭemographic data and upper GI endoscopic findings Ethics approval was obtained from Hamilton Integrated Research Ethics Board (HiREB# 14460/5415). Bonorino Udaondo Gastroenterology Hospital approved the study because of the prospective design and intervention in the Buenos Aires cohort. Figure Figure1 1 and Table Table1 1 summarize the demographic characteristics of the cohorts. Thus, the fourth cohort included CeD and non-CeD participants (controls). Bonorino Udaondo Gastroenterology Hospital, Buenos Aires Argentina) included patients referred for endoscopy and duodenal biopsy due to the presence of symptoms and/or signs compatible with CeD but, irrespective of serology, all of them part of prior research and study. The Naples/Salerno cohort included consecutive patients seen between 19, the Padua cohort between 20, and the Hamilton cohort between 20. CeD was diagnosed by positive serology and confirmed by biopsy. Two European cohorts (Universities of Naples/Salerno and Padua Italy) and a North American cohort (McMaster University, Hamilton Canada) recruited consecutive patients enrolled in local registers. Patients from four different CeD-specialized centers were included. We conducted a descriptive multicenter retrospective study on endoscopic findings from adult patients who met standard clinical, serological, and histological criteria for CeD. Finally, we studied the pathological findings in patients with a confirmed diagnosis of CeD vs those in whom the disease was ruled out. We also compared upper gastrointestinal mucosal injury diagnoses across centers and age groups. Thus, we conducted a multicenter study involving four cohorts of patients diagnosed in three countries to investigate the prevalence of coincidental upper gastrointestinal endoscopic findings in CeD patients at the time of diagnosis. However, relatively few studies have explored this in-depth, particularly in adult patients undergoing endoscopy to confirm CeD diagnosis. This is of particular concern in patients with alarm symptoms such as weight loss, anemia, or abdominal pain. However, other pediatric societies ( e.g., the North American Pediatric Gastroenterology Society) do not recommend this, in part because relevant comorbid diagnosis could be missed. Indeed, European pediatric societies recommend a non-biopsy approach under specific and strict criteria. Based on the very high specificity and predictive values of specific serology tests, the diagnosis of CeD without duodenal biopsy has been proposed in recent years. When CeD is clinically suspected, upper gastroduodenal endoscopy with duodenal biopsy confirms diagnosis. Current recommendations for diagnosing CeD in adult patients involve a combination of specific serology and a duodenal biopsy demonstrating some degree of intestinal atrophy. In the adjusted multivariate analysis of this cohort, having CeD was associated with a 72% reduction in the risk of any endoscopic abnormality (P < 0.0001), and having alarm symptoms was associated with a 37% reduction in the risk of finding at least one endoscopic lesion ( P < 0.02).Ĭeliac disease (CeD) is one of the most common life-long chronic diseases affecting people with a genetic predisposition conferred by HLA-DQ2 or DQ8. Within the South American cohort, CeD was associated with a lower rate (8.2%) of comorbid endoscopic findings compared with controls (29.1% P < 0.001). Older patients (≥ 51 years of age) had a higher prevalence of endoscopic findings than those ≤ 50 ( P < 0.01). ![]() Biopsy-confirmed Barrett’s esophagus was infrequent (0.2%). Erosive reflux esophagitis (6.4%), gastric erosions (2.0%), and suspicion of esophageal metaplasia (1.2%) were the most common findings. In 135 patients, endoscopy revealed 163 abnormalities unrelated to CeD (prevalence: 10.1%). A total of 1328 patients (80% female 35 years median age) were enrolled, of whom 95.6% had positive specific serology.
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