Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 646-652
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.646
Prediction of esophageal and gastric histology by macroscopic diagnosis during upper endoscopy in pediatric celiac disease
Erin D Boschee, Jason Y K Yap, Justine M Turner
Erin D Boschee, Department of Pediatrics, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
Erin D Boschee, Edmonton Clinic Health Academy, University of Alberta Hospital, Edmonton, Alberta T6G 2B7, Canada
Justine M Turner, Jason YK Yap, Division of Pediatric Gastroenterology, Department of Pediatrics, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
Author contributions: Boschee ED helped to design the research, performed the data collection and analysis, and wrote the manuscript; Yap JYK and Turner JM helped to design and supervise the project.
Supported by Women and Children’s Health Research Institute.
Institutional review board statement: This study was reviewed and approved by the University of Alberta Human Research Ethics Board.
Informed consent statement: Informed consent for participation in the retrospective study was not required as the analysis used anonymized data obtained after the pediatric patients’ legal guardians had agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Erin D Boschee, MD, BSc (Hons), Department of Pediatrics, University of Alberta, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada. boschee@ualberta.ca
Telephone: +1-780-8873847
Received: September 15, 2016
Peer-review started: September 18, 2016
First decision: October 28, 2016
Revised: November 10, 2016
Accepted: December 16, 2016
Article in press: December 19, 2016
Published online: January 28, 2017
Processing time: 125 Days and 22.9 Hours
Abstract
AIM

To determine the sensitivity of macroscopic appearance for predicting histological diagnosis at sites other than duodenum in pediatric celiac disease (CD).

METHODS

Endoscopic and histologic findings in pediatric patients undergoing upper endoscopy for first-time diagnosis of CD at Stollery Children’s Hospital from 2010-2012 were retrospectively reviewed.

RESULTS

Clinical charts from 140 patients were reviewed. Esophageal and gastric biopsies were taken in 54.3% and 77.9% of patients, respectively. Endoscopic appearance was normal in the esophagus and stomach in 75% and 86.2%. Endoscopic esophageal diagnoses were eosinophilic esophagitis (EE) (11.8%), esophagitis (7.9%), glycogenic acanthosis (1.3%) and non-specific abnormalities (3.9%). Endoscopic gastric diagnoses were gastritis (8.3%), pancreatic rest (0.9%), and non-specific abnormalities (4.6%). Histology was normal in 76.3% of esophageal and 87.2% of gastric specimens. Abnormal esophageal histology was EE (10.5%), esophagitis (10.5%), glycogenic acanthosis (1.3%) and non-specific (1.3%). Gastritis was reported in 12.8% of specimens. Sensitivity and specificity of normal endoscopy for predicting normal esophageal histology was 86.2% and 61.1%, and for normal gastric histology was 87.4% and 21.4%.

CONCLUSION

In the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during endoscopy for pediatric CD does not identify major pathologies. These findings have cost and time saving implications for clinical practice.

Keywords: Endoscopy; Histology; Esophagus; Gastric biopsy; Celiac disease

Core tip: We performed a retrospective chart review of esophageal and gastric endoscopic and histologic findings in pediatric patients diagnosed with celiac disease (CD). Our findings suggest that, in the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during upper endoscopy for pediatric CD does not identify major pathologies. The implication of limiting biopsies to the duodenum and duodenal bulb may be both cost and time-saving. Overall, the results of this study may have the ability to promote standardization and optimal resource allocation for routine diagnostic practices for pediatric CD.