Alexander Hann, Benjamin M Walter and Alexander Meining - Ulm Show Celiac disease is a chronic inflammation trigged by the ingestion of gluten and resulting in a dense infiltration of lymphocytes in the proximal small intestine. Classic pathological findings in histology are mucosal inflammation, crypt hyperplasia and villous atrophy. Traditionally celiac disease is diagnosed using duodenal biopsies in combination with serum autoantibodies (1). Since the improvement of video endoscopes that are used in daily practice including the introduction of narrow band imaging (NBI) and near focus, detailed examination of the duodenal mucosa results in an accurate method for the optical diagnosis (2–4). Endoscopically visible hallmarks of celiac disease are scalloped duodenal folds, grooves and fissurations (Table 1). This contrasts with healthy tissue, which is covered with finger-like villi that provide a large surface area for nutrient uptake. In celiac disease, the villi are typically much shorter and less pronounced than they are in healthy mucosa. Under endoscopy, the villous pattern can be further enhanced by the instillation of water and this approach has been regularly used in the assessment of diseases of both the duodenum and the jejunum. Water-immersion is simple, comprising the removal of air from the duodenal lumen followed by the injection of 90-150 ml of water. Thereafter, hallmarks of celiac disease such as scalloped duodenal folds, grooves and fissurations can be readily visualized. Thus, this technique enables the diagnosis of areas exhibiting villous damage in the duodenum with high accuracy (5,6). Nevertheless, although this approach acts to reduce the number of biopsies that are required, it is still necessary to confirm a diagnosis using ex vivo histopathological analysis, especially to exclude diseases that can mimic such an appearance (7).
Table 1: Endoscopically visible hallmarks of celiac disease in comparison to normal mucosa Regular folds and villi Figure 1: Left image presents regular duodenal folds. The right image presents finger-shaped villi visualized using NBI and near focus. Figure 2 Left Image presents flattened finger-shaped villi that erect after installation of 100 mL water. Both images were generated using NBI and near focus. Zöliakie im MARSH-Stadium 3Figure 3: Left image presents folds with visible fissures and nodular appearance. A closer look at the folds reveals absence of villi. Both images were generated using NBI. Figure 4: Left image displays loss of folds with a granular appearance of the mucosa. The right image generated using NBI and near focus reveals loss of villi on the mucosal surface. Figure 5: Left image presents a granular appearance of the folds including visible fissures. The right image generated using NBI and near focus reveals loss of villi. Improvement after dietary restrictionsFigure 6: Upper left image presenting the initial diagnosis of celiac disease with fissures on the folds and absence of villi when the mucosa was visualized using NBI and near focus in the right image. The lower images were obtained from the same patient after five months of gluten free diet. The lower left image presents regular folds and the right image using NBI and near focus small, but finger-like villi. References
What does celiac disease look like on an endoscopy?Endoscopically visible hallmarks of celiac disease are scalloped duodenal folds, grooves and fissurations (Table 1). This contrasts with healthy tissue, which is covered with finger-like villi that provide a large surface area for nutrient uptake.
What can be mistaken for celiac disease?Despite awareness efforts, celiac disease is often confused with other gluten-related disorders — like non-celiac gluten sensitivity (NCGS) or a wheat allergy. Both seem similar to celiac disease, but are different conditions.
Can you miss celiac on endoscopy?Therefore, we concluded that using only standard clinical suspicion and endoscopic findings was associated with a significant miss rate for celiac disease, whereas using risk factors to determine which patients required biopsy maximized the diagnosis of celiac disease and minimized unnecessary biopsies.
Can a biopsy tell if you have celiac disease?An intestinal (duodenal) biopsy is considered the “gold standard” for diagnosis because it will tell you (1) if you have celiac disease, (2) if your symptoms improve on a gluten-free diet due to a placebo effect (you feel better because you think you should) or (3) if you have a different gastrointestinal disorder or ...
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Celiac disease endoscopy pictures vs normal
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