DIAGNOSIS OF CELIAC-DISEASE AT OPEN-ACCESS ENDOSCOPY

Background: Coeliac disease may present with dyspepsia or reflux. Ther e are characteristic duodenal appearances associated with villous atro phy (mosaic pattern mucosa and loss, reduction in number or scalloping of duodenal folds) which may prompt small-bowel biopsy during routine upper gastrointestinal endoscopy. These appearances were sought in pa tients referred by their general practitioners for open-access endosco py (OAE), to determine the prevalence and significance of coeliac dise ase as a cause of symptoms. Methods: Five hundred consecutive patients undergoing OAE by one consultant gastroenterologist were studied. For ceps biopsy specimens from the distal duodenum were taken if appearanc es were suggestive. If villous atrophy was confirmed, the response of symptoms to dietary gluten exclusion was assessed. Results: Ten patien ts had suggestive endoscopic appearances, of whom eight had villous at rophy, giving a prevalence of coeliac disease of 1.6% (1:63). All eigh t had mosaic pattern mucosa, with three also having reduction of duode nal folds, and four having scalloped folds. All had serum endomysial a ntibodies (EmA). Apart from diarrhoea, described by one patient, there were no symptoms of 'typical' coeliac disease at diagnosis: three pat ients were overweight. After dietary gluten exclusion all reported sym ptomatic improvement, with disappearance of EmA in five patients to da te, Conclusions: There is a high prevalence of coeliac disease among p atients undergoing OAE, which is relevant to their clinical symptoms a nd which can he identified by careful endoscopic inspection of the duo denum.