A comparison study between Magniview and high definition white light endoscopy in detecting villous atrophy and coeliac disease: A single centre pilot study.

BACKGROUND AND AIMS: Coeliac disease may be missed at gastroscopy. We aimed to assess the sensitivity of Pentax optical zoom technology endoscopes in detecting duodenal villous atrophy and the ease of image interpretation by non-coeliac specialists. METHOD: All patients attending for a gastroscopy were assessed for endoscopic villous atrophy in part one and two of the duodenum with high definition white light endoscopy and magnification endoscopy. Endoscopic findings of the duodenum were compared to histology as the reference standard. A short training video of varying degrees of villous atrophy seen by magnification endoscopy was used to train individuals. They were then assessed for the ability to differentiate between normal duodenum and villous atrophy. RESULTS: Two hundred and fifty patients were prospectively recruited (145 females, 58%; age range 16-84, median age 50.5). Ninety-six patients had villous atrophy on histology (38.4%) 154 were controls. Magnification endoscopy had a higher sensitivity in detecting villous atrophy compared to high definition white light endoscopy (86.4% versus 78.4%, p = .0005). 9/10 individuals undertaking magnification endoscopy training correctly identified all cases of villous atrophy. CONCLUSION: Magnification endoscopy has superior diagnostic sensitivity in detecting villous atrophy compared to high definition white light endoscopy and the potential to be easily adopted by all endoscopists.

High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.

BACKGROUND AND AIMS: Celiac disease remains underdiagnosed at endoscopy. We aimed to assess the utility of I-Scan (virtual chromo-endoscopy) to improve sensitivity of endoscopy to detect markers of villous atrophy in this condition. METHODS: Patients from 2 UK hospitals were studied in 3 groups. Group 1: standard high definition, white light endoscopy (WLE); Group 2: WLE plus I-Scan; Group 3: non-high definition control group. The presence of endoscopic markers was recorded. At least 4 duodenal biopsies were taken from all patients. Serology was performed concurrently and observations were compared with histology. RESULTS: 758 patients (62% female, mean age 52) were recruited (Group 1: 230; Group 2: 228; Group 3: 300). 135 (17.8%) new diagnoses of coeliac disease were made (21 Group 1; 24 Group 2; 89 Group 3). The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 (85.7%, p=0.0004) and Group 2 (75%, p=0.005) compared to non-high definition controls (41.6%). There was no significant difference between high definition only and I-Scan groups (p=0.47). In non-high definition endoscopy a missed diagnosis was associated with lesser degrees of villous atrophy (p=0.019) and low tTG titre (p=0.007). CONCLUSIONS: High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.

Cost and availability of gluten-free food in the UK: in store and online.

OBJECTIVE: Coeliac disease (CD) is a lifelong condition requiring strict adherence to a gluten-free (GF) diet and good availability of GF foods is critical to this. Patients with CD from lower socioeconomic groups are recognised to have higher treatment burden and higher food costs may impact this. Therefore, we aimed to assess the availability and cost of GF food in supermarkets and via the internet. DESIGN: Supermarkets and internet shops delivering to homes in a single city (UK) were analysed between February and March 2014. Stores were identified with comprehensive internet searches. Ten commonly purchased items were analysed for cost and compared with standard non-GF alternatives. Direct measurement of the number of GF foods available was compared between stores which were categorised according to previously published work. SETTING: Supermarkets covering the whole of Sheffield, UK. RESULTS: None of the budget supermarkets surveyed stocked any GF foods. Quality and regular supermarkets stocked the greatest range, each stocking a median of 22 (IQR 39) items (p<0.0001). All GF foods were at least four times more expensive than non-GF alternatives (p<0.0001). GF products are prevalent online, but 5/10 of the surveyed products were significantly more expensive than equivalents in supermarkets. CONCLUSIONS: There is good availability of GF food in regular and quality supermarkets as well as online, but it remains significantly more expensive. Budget supermarkets which tend to be frequented by patients from lower socioeconomic classes stocked no GF foods. This poor availability and added cost is likely to impact on adherence in deprived groups.