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. 2022 Mar 10;12(3):678.
doi: 10.3390/diagnostics12030678.

In Elderly Anemic Patients without Endoscopic Signs of Bleeding Are Duodenal Biopsies Always Necessary to Rule Out Celiac Disease?

Giulia Pivetta  1 , Chiara Coluccio  1 , Emanuele Dilaghi  1 , Edith Lahner  1 , Emanuela Pilozzi  2 , Marilia Carabotti  1 , Vito Domenico Corleto  1
Affiliations

In Elderly Anemic Patients without Endoscopic Signs of Bleeding Are Duodenal Biopsies Always Necessary to Rule Out Celiac Disease?

Giulia Pivetta et al. Diagnostics (Basel). .

Abstract

Iron-deficiency anemia in the elderly may be due to numerous gastrointestinal conditions. Anemia is frequent in celiac disease (CD); however, the use of routine duodenal biopsies, independently of age or serology, is debated. To determine the diagnostic yield of routine duodenal biopsies in adult and elderly patients with no bleeding anemia, a cross-sectional study analyzing 7968 gastroscopies (2017−2020) was performed; 744 were for anemia and 275 were excluded (GI bleeding or without duodenal biopsies). Of the 469 included patients, clinical, endoscopic, and histological features were analyzed in groups with or without histopathological changes in the duodenal mucosa (DM). Univariate/multivariate analyses were performed. Of the 469 patients, 41 (8.7%) had DM histopathological changes, 12 (2.6%) had CD, 26 (5.5%) had duodenal intraepithelial lymphocytosis (DIL), and 3 had (0.6%) other conditions. They were younger compared to patients with normal DM. DM histopathology was significantly inversely correlated with age group, with prevalences of 27%, 20%, 12.5%, 10%, and 2.5%, in the <40−50, 51−60, 61−70, 71−80, and >80-year age groups, respectively (p = 0.0010). Logistic-regression models showed that anemic patients aged >60, >70, or >80 years with endoscopically normal DM had a progressively three- to four-fold higher probability of having normal duodenal histology. In adults, anemic patients without bleeding, age and endoscopically normal DM are predictors of normal DM histology. In >70-year anemic patients, negligible DM pathology was found. The results suggest that routine duodenal biopsies are questionable in elderly anemic patients

Keywords: anemia; celiac disease; duodenal biopsies.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart. EGDS = esophagealgastroduodenoscopy; GI = gastrointestinal.
Figure 2
Figure 2
Pathological duodenal findings with respect to age. Legend: 1 = celiac disease, 2 = duodenal intraepithelial lymphocytosis, 3 other findings (Giardia L infection, chemical duodenitis).
Figure 3
Figure 3
Decreasing frequency of histopathological duodenal alterations with increasing age.
See this image and copyright information in PMC

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