Endoscopic features of celiac disease in children

Background. Endoscopic abnormalities have been described in adult patients with celiac disease that may suggest the diagnosis, especially when the pre sentation is atypical. Methods: The duodenum of 140 children undergoing EGD for various different indications was evaluated macroscopically and histologically. Results: Histology revealed total villous atrophy in 80 patients, 79 of who m had celiac disease. Among these, 100% had a mucosal mosaic pattern in the duodenum (sensitivity 98.7%, specificity 96.7%, positive predictive value 97.5%, negative predictive value 98.3%), 70% had scalloped duodenal folds ( sensitivity 68.7%, specificity 98.3%, positive predictive value 98.2%, nega tive predictive value 70.2%),15% had visible vasculature, and 6% had reduct ion of duodenal folds. Sensitivity and specificity of endoscopic findings w ere not modified by chromoendoscopy. Except for the mosaic pattern, the fre quency of endoscopic abnormalities increased with age; reduction of duodena l folds was never seen in children with celiac disease who were less than 5 years of age. Conclusions: The frequency and diagnostic value of endoscopic abnormalities are different in children with celiac disease compared with adults with th is disease. Because indications for endoscopy, such as abdominal pain, dysp epsia, and unexplained anemia, can be manifestations of celiac disease, and villous atrophy may have a patchy distribution, awareness of these endosco pic abnormalities is important in the diagnosis of celiac disease in childr en.