Original articleClinical endoscopyDifficult diagnosis of celiac disease: diagnostic accuracy and utility of chromo-zoom endoscopy
Section snippets
Aims
This study aimed to evaluate the diagnostic accuracy of zoom-endoscopy combining with indigo carmine dye spray in the direct evaluation of duodenal villi in patients with a difficult diagnosis and to compare the findings with a recent reference standard, which is the in vitro gliadin challenge test.
Study design
The accuracy of chromo-zoom endoscopy was evaluated in patients in whom CD had been excluded (negative controls), in patients with serology-proven and biopsy-proven CD (positive controls), and in cases in which the diagnosis of CD was difficult (Fig. 1).
Patients
Three groups of patients were recruited at the CD center, Gastroenterology Unit, at the University of Naples Federico II, and included in this study: a negative control group, a positive control group, and a difficult diagnosis group. The
Demographic characteristics
A total of 80 patients were enrolled in the study. Two were excluded for contamination of samples and another for inadequate (superficial) biopsy samples. Table 2 shows the sex, age, anthropometry, and clinical features of the participants.
Sex and age had a similar distribution among the difficult diagnosis, the negative control, and the positive control groups (Fisher exact test 0.27; P = .93 and analysis of variance P = .30, respectively). Serum a-tTG values averaged in the normal range in
Discussion
Our results confirm that the chromo-zoom endoscopy has a high accuracy in the identification of untreated patients with CD and negative controls. The novel finding of our study was that chromo-zoom endoscopy is highly accurate for diagnosing difficult cases of CD with high specificity and high sensitivity; however, this applies only to patients on a normal gluten-containing diet.
Currently, the criterion standard for the diagnosis of CD remains in the histologic demonstration of the
Acknowledgment
The authors are grateful to Dr Vincenzo Bruno for technical support, to Mrs Imma Di Palma and Mrs Speranza Iovino for their nursing assistance, and to Mrs Piantedosi for secretarial assistance.
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DISCLOSURE: The following authors disclosed a financial relationship: Drs Russo and Ciacci received support for this study from the Italian Research Program (PRIN 2006) and by Regione Campania, Assessorato Sanità. None of the funders had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. No other financial relationships relevant to this publication were disclosed.