Endoscopic Signs in Celiac Disease

Abstract

We read with interest the article by Tursi et al. [1], dealing with the relationships between the endoscopic signs of celiac disease, histological damage, age of the patients, and the clinical form of the disease. Their conclusions stated that the endoscopic appearance of the duodenum may be predictive of the grade of histological damage, and that in young patients with subclinical or silent celiac disease, there is a greater probability of finding milder endoscopic abnormalities associated with milder histological damage. We agree in part with these conclusions; other authors have suggested that the presence of endoscopic signs in celiac disease increases as villous atrophy becomes more evident [2] [3] and that in childhood, some endoscopic signs are more frequent than others [4] [5]. However, in our opinion simpler and more useful data can be drawn from the results obtained by the authors, taking into account the distribution of the normal endoscopic appearance of the duodenum among Marsh histological classes (Table 1 in [1]), age groups (Table 2 in [1]), and clinical forms of the disease (Table 3 in [1]).