Rates of Duodenal Biopsy During Upper Endoscopy Differ Widely Between Providers: Implications for Diagnosis of Celiac Disease

Overview

Journal J Clin Gastroenterol

Specialty Gastroenterology

Date 2017 Nov 3

PMID 29095420

Citations 3

Authors

Max Pitman

David S Sanders

Peter H R Green

Benjamin Lebwohl

Affiliations

Soon will be listed here.

Abstract

Goal: The goal of this study is to determine factors associated with performance of duodenal biopsy during upper endoscopy.

Background: Celiac disease (CD) prevalence approaches 1% in the United States and Europe, yet CD remains underdiagnosed, in part because of low rates of duodenal biopsy during upper endoscopy. We aimed to identify patient and provider factors associated with performance of duodenal biopsy during upper endoscopy.

Study: In our hospital-based endoscopy suite, we identified all patients not previously diagnosed with CD who underwent upper endoscopy during a 5-year period for one of the following indications: abdominal pain/dyspepsia, gastroesophageal reflux (GERD), anemia/iron deficiency, diarrhea, and weight loss. We employed univariate and multivariate analysis to determine the association between clinical factors and the performance of duodenal biopsy.

Results: Of 8572 patients included in the study, 4863 (57%) underwent duodenal biopsy. Of those who underwent duodenal biopsy, 24 (0.49%) were found to have CD. On multivariate analysis, age, gender, indication, gross endoscopic appearance, physician affiliation with a celiac disease center, and absence of a participating trainee were all significantly associated with the performance of duodenal biopsy. There was wide variability among providers, with duodenal biopsy rates ranging from 27% to 91% during these procedures.

Conclusions: A duodenal biopsy is more likely to be performed in younger patients, females, and for key indications such as weight loss, diarrhea, and anemia. Providers varied widely in the performance of duodenal biopsy. Further study is warranted to better understand the decision to perform duodenal biopsy and to determine the optimal scenarios for its performance.

Citing Articles

Routine Multiple Duodenal Biopsy during Endoscopy of Dyspeptic Patients Seems Unnecessary for Screening of Celiac Disease.

Behforouz A, Esmaeelzadeh A, Mosanan Mozaffari H, Mokhtarifar A, Faravani E, Amoueian S Gastroenterol Res Pract. 2021; 2020:6664741.

PMID: 33424963 PMC: 7772036. DOI: 10.1155/2020/6664741.

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia.

Rockey D, Altayar O, Falck-Ytter Y, Kalmaz D Gastroenterology. 2020; 159(3):1097-1119.

PMID: 32828801 PMC: 10824166. DOI: 10.1053/j.gastro.2020.06.045.

Prevalence and Clinical Features of Celiac Disease in Healthy School-Aged Children.

Beser O, Gulluelli E, Cullu Cokugras F, Erkan T, Kutlu T, Yagci R Dig Dis Sci. 2018; 64(1):173-181.

PMID: 30311156 DOI: 10.1007/s10620-018-5320-0.

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