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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
ARTICLE HIGHLIGHTS
Research background
Celiac disease (CeD) is currently diagnosed in adult patients using a combination of specific serology tests and a duodenal biopsy obtained through an upper endoscopy. Upper endoscopy is also considered necessary for CeD diagnosis because non-CeD comorbidities can be missed.
Research motivation
The prevalence of upper gastrointestinal comorbidities at the time of CeD diagnosis has received little attention.
Research objectives
To investigate the prevalence of coincidental upper gastrointestinal endoscopic findings at the time of diagnostic endoscopy in four cohorts of patients diagnosed in three different countries.
Research methods
We conducted a descriptive multicenter retrospective study reporting endoscopic findings from adult patients who met standard criteria for diagnosing CeD.
Research results
Of 1328 adult patients enrolled, 95.6% had positive specific serology. In 135 patients, endoscopy revealed 163 abnormalities unrelated to CeD (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 other neoplastic or malignancies lesions were detected. Patients with alarm symptoms or signs had a lower rate of concomitant findings.
Research conclusions
Adults with positive CeD serology had few comorbid endoscopic findings when CeD was diagnosed.
Research perspectives
These findings raise the possibility that adult patients who meet recommended and strict serological criteria for CeD could be diagnosed without undergoing endoscopy and biopsy.
