Summary:
Endoscopy of the duodenum up to the aboral part of the
descending arm may reveal macroscopic alterations suggestive
of celiac sprue. These changes include: Kerkring’s
folds reduced in height and number or absent, scalloping
of folds, a mosaic pattern of mucosa and visible underlying
blood vessels. Sensitivity, specificity, positive and negative
predictive values of these parameters differ in
relation the characteristics of the examined series of probands.
Duodenoscopy may be the first examination arising
suspicion of celiac sprue, particularly in subjects
with atypical symptomatology. Upper endoscopy is frequently
a part of the basic diagnostic programme in these
subjects. For this reason it is mandatory that during this
procedure aboral duodenum should be scoped in a standardized
and detailed manner. Biopsy of the aboral duodenum
is an acceptable alternative to jejunal biopsies for
histological diagnosis of celiac sprue. Push enteroscopy is
preferable in refractory sprue, particularly if ulcerative
jejunitis is suspected. Early diagnosis of celiac sprue is
necessary for introduction of the gluten-free diet as well
as for the reduction of complications and associated autoimmune
diseases.
Key words:
celiac sprue, duodenoscopy, push enteroscopy,
macroscopic changes, histology
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