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. 2013 Jul;27(7):405-8.
doi: 10.1155/2013/347902.

Detection of adult celiac disease with duodenal screening biopsies over a 30-year period

Hugh James Freeman  1
Affiliations

Detection of adult celiac disease with duodenal screening biopsies over a 30-year period

Hugh James Freeman. Can J Gastroenterol. 2013 Jul.

Abstract
in English, French

Background: Serological studies suggest that celiac disease may be present in approximately 0.5% to 1% of the North American population. Screening data based on small intestinal biopsy performed during routine endoscopic evaluations are not available.

Methods: Patients referred between January 1982 and December 2011 for evaluation of gastrointestinal symptoms and requiring elective investigative upper endoscopic evaluation underwent duodenal biopsies to determine whether changes of adult celiac disease were present.

Results: A total of 9665 patients, including 4008 (41.5%) males and 5657 (68.5%) females, underwent elective endoscopies and duodenal biopsies. Of these, 234 (2.4%) exhibited changes of celiac disease including 73 males (1.8%) and 161 females (2.8%). During the first 20 years, the number of biopsy-positive patients in five-year intervals progressively decreased and, subsequently, during the next 10 years, the number progressively increased.

Conclusions: Celiac disease is far more common in specialist practice than has been suggested in the evaluation of healthy populations using serological screening studies. Endoscopic duodenal biopsy is an important method of identifying underlying celiac disease and should be routinely considered in all patients undergoing an elective endoscopic evaluation. Noninherited factors, possibly environmental, may play a role in the appearance of biopsy-defined celiac disease and alter detection over time.

HISTORIQUE :: Les études sérologiques laissent supposer que de 0,5 % à 1,0 % de la population nord-américaine serait atteinte de la maladie cœliaque. On ne possède pas de données de dépistage fondées sur une biopsie de l’intestin grêle effectuée pendant les évaluations endoscopiques systématiques.

MÉTHODOLOGIE :: Les patients aiguillés entre janvier 1982 et décembre 2011 pour faire évaluer des symptômes gastro-intestinaux et ayant besoin d’une évaluation endoscopique non urgente par voie haute ont subi une biopsie du duodénum pour déterminer s’ils présen-taient les changements propres à la maladie cœliaque chez l’adulte.

RÉSULTATS :: Au total, 9 665 patients, soit 4 008 hommes (41,5 %) et 5 657 femmes (68,5 %), ont subi des endoscopies non urgentes et des biopsies du duodénum. De ce nombre, 234 (2,4 %), soit 73 hommes (1,8 %) et 161 femmes (2,8 %), présentaient les changements liés à la maladie cœliaque. Pendant les 20 premières années, le nombre de patients dont la biopsie avait été positive aux intervalles de cinq ans a diminué progressivement, et pendant les dix années suivantes, ce nom-bre a augmenté progressivement.

CONCLUSIONS :: La maladie cœliaque est beaucoup plus courante dans les cabinets de spécialistes que le laissait supposer l’évaluation de populations en santé au moyen d’études de dépistage sérologique. La biopsie du duodénum par endoscopie représente une méthode importante pour dépister une maladie cœliaque sous-jacente et devrait être systématiquement envisagée chez tous les patients qui subissent une évaluation endoscopique non urgente. Des facteurs non congénitaux, peut-être de nature environnementale, peuvent jouer un rôle dans l’apparition de la maladie cœliaque définie par biopsie et en modifier le dépistage au fil du temps.

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Figures

Figure 1)
Figure 1)
Males (n=4008) and females (n=5657) undergoing an elective endoscopy (with duodenal biopsies) from 1982 to 2011. Note: <30 denotes males and females 30 years of age or younger
Figure 2)
Figure 2)
Study intervals (five-year) from 1982 to 2011 for males and females
Figure 3)
Figure 3)
Age ranges with newly-diagnosed celiac disease. Note: <30 denotes 30 years of age or younger
Figure 4)
Figure 4)
Age ranges of males and females with newly diagnosed celiac disease. Note: <30 denotes 30 years of age or younger
Figure 5)
Figure 5)
Study intervals (five-year) for biopsy-positive patients with newly diagnosed celiac disease from 1982 to 2011
See this image and copyright information in PMC

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