Endoscopic features of celiac disease in adults and their correlation with age, histological damage, and clinical form of the disease.

ABSTRACT

BACKGROUND AND STUDY AIMS: Although earlier studies have focused on endoscopic markers as predictors of celiac disease, there are still no certainties about the value of these markers. The aim of this study was to consider first, specific endoscopic features as predictors of specific histological damage; secondly, whether there is an association between the endoscopic features of celiac disease and the age of patients at the time of diagnosis; and thirdly, whether particular endoscopic features of celiac disease are associated with the clinical form of the disease. PATIENTS AND METHODS: We studied the endoscopic features of celiac disease in 144 consecutive adult patients (52 had the classical form of the disease, 64 the subclinical and 28 the silent form). The histopathological findings were expressed according to the Marsh classification. RESULTS: Slight/mild damage seen at endoscopy was associated with a Marsh II-IIIa grading (P < 0.005), while severe endoscopic damage was related to a Marsh IIIb-IIIc grading (P < 0.0005). Younger patients showed slighter damage at endoscopy (P < 0.001), while older patients showed more severe damage (P < 0.005). Finally, the classical form of celiac disease showed more severe damage at endoscopy, while the subclinical/silent forms of celiac disease showed slighter damage endoscopically (P < 0.001). CONCLUSIONS: This study showed that the endoscopic appearance of the duodenum may be predictive of histological damage grading. Moreover, we showed that in young patients with subclinical/silent celiac disease there is a greater probability of finding slight/mild endoscopic abnormalities associated with slight/mild histological damage.