1871 Rare Case of Endoscopic Erosive Ulcerations in Celiac Disease

Abstract

INTRODUCTION: Celiac disease is a common disorder of the small intestine caused by an autoimmune reaction to dietary gluten in the setting of genetic predisposition. Patients can present with a variety of symptoms ranging from diarrhea and unintentional weight loss to extraintestinal signs such as iron deficiency anemia and dermatitis. The diagnosis is confirmed with serologies and duodenal biopsies while a patient is on a gluten-containing diet. Histopathology of the small bowel demonstrates characteristic villous atrophy, mucosal inflammation, or crypt hyperplasia with increased intraepithelial lymphocytes. Gross endoscopic findings are typically normal with occasional endoscopies can show gastritis or atrophy. This is the first case of celiac disease with gross endoscopic findings consistent with non-bleeding erosive gastropathy. CASE DESCRIPTION/METHODS: A 68-year-old Veteran male presents for evaluation of weight loss, left lower quadrant discomfort and chronic loose stools. He denied any dietary changes, changes in appetite, nausea, vomiting, skin lesions, joint pain or recent travel. Endoscopy was performed demonstrating petechial gastropathy in the proximal stomach, mild duodenal bulb erosions with marked transverse-oriented erosions from the second part of the duodenum to proximal jejunum. Jejunal and duodenal biopsies were consistent with Celiac disease without H pylori, intestinal dysplasia or metaplasia. Serum TSH was 0.876, IgA was 276 (normal 58-484 mg/dL), Tissue transglutaminase IgA >100 U/mL and gastrin <15 pg/mL. DISCUSSION: The chronic lymphocytic infiltration triggered by the ingestion of gluten causes the classic histopathological findings. However, endoscopically, celiac disease has not been shown to have significant features outside of scalloped duodenal folds, fissures and grooves. This is the first documented case that presents an endoscopic pattern of erosive ulcerations consistent both histologically and serologically with celiac disease. While biopsy remains the standard of care, further exploration into diagnosing this disease through gross pathology is warranted.