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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Upper gastrointestinal endoscopic findings in celiac disease at diagnosis: A multicenter international retrospective study
Juan Pablo Stefanolo, Fabiana Zingone, Carolina Gizzi, Ilaria Marsilio, María Luján Espinet, Edgardo Gustavo Smecuol, Mark Khaouli, María Laura Moreno, María I Pinto-Sánchez, Sonia Isabel Niveloni, Elena F Verdú, Carolina Ciacci, Julio César Bai
Juan Pablo Stefanolo, María Luján Espinet, Edgardo Gustavo Smecuol, María Laura Moreno, Sonia Isabel Niveloni, Julio César Bai, Small Bowel Section, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
Fabiana Zingone, Ilaria Marsilio, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova 35124, Italy
Fabiana Zingone, Gastroenterology Unit, Azienda Ospedale Università, Padova 35128, Italy
Carolina Gizzi, Carolina Ciacci, Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno 84081, Italy
Mark Khaouli, María I Pinto-Sánchez, Elena F Verdú, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton L8S 4K1, Canada
Julio César Bai, Research Institutes, Universidad del Salvador, Buenos Aires 1020, Argentina
Author contributions: Stefanolo JP, Ciacci C, Zingone F, Gizzi C, Marsilio I, Espinet ML, Pinto-Sánchez MI, and Niveloni SI contributed with data acquisition; Stefanolo JP performed the statistical analysis; Stefanolo JP, Pinto-Sánchez MI, Ciacci C, Zingone F, and Bai JC contributed to study design; Verdú EF, Smecuol EG, Moreno ML contributed to critical analysis; Bai JC, Verdú EF, Ciacci C, Pinto-Sánchez MI and Zingone F contributed to writing and critical review of the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: The Ethics and Research Board of the Dr. C. Bonorino Udaondo Gastroenterology Hospital approved the study because of the prospective design and intervention in the Buenos Aires cohort. Ethics approval was obtained from the Hamilton Integrated Research Ethics Board (HiREB# 14460/5415). In Italy, Ethical Committee review was not required for retrospective studies while patient data remained anonymously coded.
Informed consent statement: Informed consent was not required by the Ethics and Research Committee of the Hospital de Gastroenterología Dr. C. Bonorino Udaondo (Buenos Aires, Argentina) given the retrospective nature of the study and because this study was categorized as minimal risk by the Committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at jbai@intramed.net. Consent was not obtained, but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Julio César Bai, MD, Academic Research, Emeritus Professor, Small Bowel Section, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Av. Caseros 2061, Buenos Aires 1264, Argentina. jbai@intramed.net
Received: August 24, 2022
Peer-review started: August 24, 2022
First decision: September 8, 2022
Revised: September 22, 2022
Accepted: November 7, 2022
Article in press: November 7, 2022
Published online: November 21, 2022
BACKGROUND
Gastroduodenal endoscopy and biopsy following positive specific serology is considered the gold standard to diagnose celiac disease (CeD) in adults. Whether upper endoscopy helps detect comorbid conditions is unknown.
AIM
To investigate the prevalence of non-celiac endoscopic findings in patients in whom endoscopy was performed to confirm CeD diagnosis.
METHODS
This is an observational, descriptive, multicenter, retrospective study that reports endoscopic findings obtained in adult patients enrolled in local registries from four tertiary centers. We collected data reported on first endoscopy, indicated for investigation of CeD. Diagnosis of CeD was performed by histology (≥ Marsh 2 type mucosal damage) and specific serology. Two European and one North American center included biopsy-confirmed CeD following positive serology. A fourth center (South America) included symptomatic patients undergoing endoscopy, irrespective of CeD serology. The latter cohort included a non-CeD control group.
RESULTS
A total of 1328 patients (80% female; 35 years median age) were enrolled, of whom 95.6% had positive specific serology. In 135 patients, endoscopy revealed 163 abnormalities unrelated to CeD (prevalence: 10.1%). Erosive reflux esophagitis (6.4%), gastric erosions (2.0%), and suspicion of esophageal metaplasia (1.2%) were the most common findings. Biopsy-confirmed Barrett’s esophagus was infrequent (0.2%). No endoscopic cancer was detected. Older patients (≥ 51 years of age) had a higher prevalence of endoscopic findings than those ≤ 50 (P < 0.01). 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). 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).
CONCLUSION
In this large multicenter study, young adults with positive CeD serology had few comorbid endoscopic findings. Although patients over 51 years had a high prevalence of non-CeD gastroduodenal mucosal damage, no malignancy or premalignant lesions were found.
Core Tip: We offer novel data on the prevalence of non-celiac endoscopic findings at the time of endoscopy performed to confirm celiac disease (CeD) diagnosis. Based on the very high performance of specific serology tests, the diagnosis of CeD without duodenal biopsy has been proposed in recent years. However, some guidelines do not recommend avoiding endoscopy because relevant comorbid diagnosis can be missed. Our results found that comorbid upper gastrointestinal endoscopic pathology is uncommon in patients with positive CeD serology at the time of diagnostic endoscopy suggesting that a non-biopsy strategy is unlikely to clinically miss significant concomitant endoscopic findings unrelated to CeD.
