Abstract
BackgroundClinical algorithms for the workup of celiac disease often recommend the use of serologic assays for initial screening, followed by duodenal biopsy for histologic confirmation. However, the majority of duodenal biopsies submitted to pathology for “rule out celiac” are negative. The objective of this study was to determine the underlying causes for this low diagnostic yield.MethodsWe performed a retrospective review of pathology reports from 1432 consecutive duodenal biopsies submitted for pathologic assessment to “rule out celiac” and correlated biopsy results with results for concurrent serologic testing for celiac autoantibodies.ResultsThe majority of patients had no record of serologic testing prior to biopsy, and evidence of positive serology results was found in only 5% of patients. Most duodenal biopsies were submitted as part of a multi-site GI sampling strategy that included biopsies from other locations. In this context, serologic results correlated with the likelihood of significant duodenal and non-duodenal findings, and were also helpful in evaluating patients with indeterminate duodenal histology.ConclusionsThe presence of a positive screening test for celiac autoantibodies does not appear to be a major driver in the decision to submit duodenal biopsies for evaluation of celiac disease, which accounts for the low incidence of findings in these samples. In patients where celiac serology testing was performed, the results were a good predictor of the likelihood of findings on biopsy.
Highlights
Clinical algorithms for the workup of celiac disease often recommend the use of serologic assays for initial screening, followed by duodenal biopsy for histologic confirmation
In an effort to understand the causes for this discrepancy, we retrospectively examined the utilization of celiac serology in a cohort of patients who had been sent for duodenal biopsy
During the 6 month period of the study, 1432 duodenal biopsies were received where celiac disease was part of the differential specified in the pathology request
Summary
Clinical algorithms for the workup of celiac disease often recommend the use of serologic assays for initial screening, followed by duodenal biopsy for histologic confirmation. Celiac disease is one of the most common autoimmune diseases, with an estimated prevalence of approximately 1% in various populations [1,2,3]. The disease is caused by an autoimmune response to gluten which leads to progressive villous atrophy in the small bowel, resulting in malabsorption. Can include iron deficiency anemia and fatigue. Accurate recognition and diagnosis of celiac disease is important because implementation of a gluten-free diet can ameliorate many symptoms. Celiac disease is associated with increased mortality in adult life from a range of causes, including autoimmune diseases and malignancy [4,5]
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