Histologic characteristics in duodenal biopsy specimens for CD were evaluated according to the modified Marsh Classification. milder enteropathy (Marsh 0-II) have a low specificity for CD. The prevalence of CD among dyspeptic individuals is significantly (2.5%) higher than in the general population (1%) and CD should be investigated in these patients. detection and biopsies from the second part of the duodenum for histological processing. Histological diagnosis of CD was based on the presence of intraepithelial lymphocytes, crypts hyperplasia and/or villous atrophy. Biopsy results were classified as absence of CD (Marsh 0) or suggestive of CD (Marsh II to IIIc), according to modified Marsh criteria (13, 14). The histological specimens were examined by two pathologists who did not know the endoscopic results and clinical history of the patients. The sera of these patients were analyzed for IgA class human antitissue transglutaminase (tTG) antibody and total serum IgA values according to standardized methods (15). Serological data were correlated to the endoscopic results and to the histological pattern observed in the small intestine. All patients with confirmed CD diagnosis were treated with a gluten free diet and followed. Statistical analysis was performed using SPSS software, version 13.5. Descriptive variables such as mean, median and standard deviation were determined. Chi-square (2) test was performed to find out the association between CD and risk factors. Results The mean age of the patients was 36.1 years. The gastroenterology symptoms in the subjects were: 78% abdominal pain, 70% bloating, 58% heart burn, 46% early satiety, 32% nausea, 32% flatulence, 31% weight loss and 22% anorexia. Recurrent abdominal pain, heart burn and bloating were present in 60%, 45% and 31% of the patients, respectively (Figure 1). Open in a separate window Figure 1 Current endoscopy findings in study population was detected in 90.5% cases. There were 26 cases with enteropathy (12 Marsh I, 4 Marsh II, 2 Marsh IIIa, 6 Marsh IIIb and 2 Marsh IIIc). Four of 407 dyspeptic patients were IgA deficient and all of them were negative for IgG tTG. Thirty three (8.1%) of the 407 patients tested had tTGA level more than 15 u/ml and considered as tTGA positive. Twenty three of 33 seropositive had normal small bowel mucosa. The demographic, histologic and serologic characteristics of 33 patients with serology positive and 26 with abnormal histology are shown in Table 1. Table 1 Clinical and laboratory features of seropositive patients thead th align=”left” rowspan=”1″ colspan=”1″ Subjects /th th align=”center” rowspan=”1″ colspan=”1″ Abnormal histology patients /th th align=”center” rowspan=”1″ LFM-A13 colspan=”1″ Seropositive patients /th /thead No. of cases 2633 Mean age (yrs) 37.942.6 Gender ?Male1115?Female1320 GI symptoms ?abdominal discomfort1825?anorexia68?weight loss119?nausea59?heart burn1410?early satiety89?flatulence78?Bloating1215 em H. pylori /em 2126 Celiac disease 1010 Open in a separate window In 10 of 33 tTGA positive patients, CD was confirmed by histological analysis of the intestinal biopsy samples, giving a prevalence of CD of 2.45%. Five of these 10 celiac patients were Marsh Leuprorelin Acetate IIIa-c followed by 3 Marsh I and 2 Marsh II. The highest rate of histological abnormalities and of CD seropositivity was found in the age categories of 21-30 years and 10-20 years respectively (Table 2). Table 2 Cases with histology and serology consistent with celiac disease thead th align=”left” rowspan=”1″ colspan=”1″ Marsh classification /th th align=”center” LFM-A13 rowspan=”1″ colspan=”1″ No. of patients /th th align=”center” colspan=”2″ rowspan=”1″ Gender /th th align=”center” rowspan=”1″ colspan=”1″ Mean age (yrs) /th th align=”left” rowspan=”1″ colspan=”1″ /th th align=”left” rowspan=”1″ colspan=”1″ /th th colspan=”2″ align=”left” rowspan=”1″ hr / /th th align=”left” LFM-A13 rowspan=”1″ colspan=”1″ /th th align=”left” rowspan=”1″ colspan=”1″ /th th align=”center” rowspan=”1″ colspan=”1″ /th th align=”center” rowspan=”1″ colspan=”1″ Female /th th align=”center” rowspan=”1″ colspan=”1″ Male /th th align=”center” rowspan=”1″ colspan=”1″ /th /thead Marsh I32127.3Marsh II21139Marsh III (a-c)54126.8tTG +ve with normal histology23121148.3 Open in a separate window Discussion Dyspepsia is a highly prevalent and heterogeneous disorder (16). We know that damages in CD are not confined to the small intestine (17) and not every celiac patient develop severe mucosal small bowel abnormality. Several studies have demonstrated that chronic exposure to gluten may damage the structure and function of the gastric mucosa in CD patients (18, 19). Other surveys indicate that approximately 20% of patients with dyspeptic symptoms have erosive esophagitis, 20% are estimated to have endoscopy-negative reflux disease, 10% have peptic ulcer, 2% have Barrett esophagus and 1% or less have malignancy (20) and the results of the present study suggest that at least 2-3% CD in dyspeptic patients should be e added to the list. However,.
Categories