Optical coherence tomography in pediatric patients: A feasible technique for diagnosing celiac disease in children with villous atrophy

E. Masci, B. Mangiavillano, G. Barera, B. Parma, L. Albarello, A. Mariani, C. Doglioni, P. A. Testoni

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background and aim: Celiac disease is a common condition with many atypical manifestations, where histology serves as the "gold standard" for diagnosis. A useful new technique, optical coherence tomography, can depict villous morphology in detail, using light waves. This study examined the correlation between the sensitivity and specificity of optical coherence tomography in pediatric patients undergoing esophago-gastro-duodenoscopy for the diagnosis of celiac disease. Materials and methods: A total of 134 children were prospectively enrolled, 67 with a serological suspicion of celiac disease (group 1) and 67 with negative histology for celiac disease (group 2). During a diagnostic esophago-gastro-duodenoscopy we acquired multiple images and films in the four quadrants of the second part of the duodenum, and biopsies were taken in the area where optical coherence tomography had been done. Three patterns of villous morphology were considered: pattern 1 = no atrophy (types 0, 1 or 2 of the Marsh classification); pattern 2 = mild atrophy (type 3a or 3b); pattern 3 = marked atrophy (type 3c). Results: The diagnosis of celiac disease was histologically confirmed in all 67 children with positive antiendomysium and/or antitransglutaminase antibodies. Optical coherence tomography correlated with pattern 1 histology in 11/11 cases, pattern 2 in 30/32 (93.8%) and pattern 3 in 22/24 (91.6%). Sensitivity and specificity were 82% and 100%. In the control group there was 100% concordance between optical coherence tomography and histology. The overall concordance between optical coherence tomography and histology in determining patchy lesions was 75%. Conclusion: Optical coherence tomography could be a helpful diagnostic tool in children with mild or marked villous atrophy for diagnosing celiac disease during upper gastrointestinal (GI) endoscopy, avoiding biopsies. However, duodenal biopsies are mandatory if the optical coherence tomography shows normal villous morphology in patients with positive antibodies.

Original languageEnglish
Pages (from-to)639-643
Number of pages5
JournalDigestive and Liver Disease
Volume41
Issue number9
DOIs
Publication statusPublished - Sep 2009

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Optical Coherence Tomography
Celiac Disease
Atrophy
Pediatrics
Histology
Duodenoscopy
Biopsy
Sensitivity and Specificity
Gastrointestinal Endoscopy
Antibodies
Wetlands
Duodenum
Light
Control Groups

Keywords

  • Celiac disease
  • Optical coherence tomography

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Optical coherence tomography in pediatric patients : A feasible technique for diagnosing celiac disease in children with villous atrophy. / Masci, E.; Mangiavillano, B.; Barera, G.; Parma, B.; Albarello, L.; Mariani, A.; Doglioni, C.; Testoni, P. A.

In: Digestive and Liver Disease, Vol. 41, No. 9, 09.2009, p. 639-643.

Research output: Contribution to journalArticle

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abstract = "Background and aim: Celiac disease is a common condition with many atypical manifestations, where histology serves as the {"}gold standard{"} for diagnosis. A useful new technique, optical coherence tomography, can depict villous morphology in detail, using light waves. This study examined the correlation between the sensitivity and specificity of optical coherence tomography in pediatric patients undergoing esophago-gastro-duodenoscopy for the diagnosis of celiac disease. Materials and methods: A total of 134 children were prospectively enrolled, 67 with a serological suspicion of celiac disease (group 1) and 67 with negative histology for celiac disease (group 2). During a diagnostic esophago-gastro-duodenoscopy we acquired multiple images and films in the four quadrants of the second part of the duodenum, and biopsies were taken in the area where optical coherence tomography had been done. Three patterns of villous morphology were considered: pattern 1 = no atrophy (types 0, 1 or 2 of the Marsh classification); pattern 2 = mild atrophy (type 3a or 3b); pattern 3 = marked atrophy (type 3c). Results: The diagnosis of celiac disease was histologically confirmed in all 67 children with positive antiendomysium and/or antitransglutaminase antibodies. Optical coherence tomography correlated with pattern 1 histology in 11/11 cases, pattern 2 in 30/32 (93.8{\%}) and pattern 3 in 22/24 (91.6{\%}). Sensitivity and specificity were 82{\%} and 100{\%}. In the control group there was 100{\%} concordance between optical coherence tomography and histology. The overall concordance between optical coherence tomography and histology in determining patchy lesions was 75{\%}. Conclusion: Optical coherence tomography could be a helpful diagnostic tool in children with mild or marked villous atrophy for diagnosing celiac disease during upper gastrointestinal (GI) endoscopy, avoiding biopsies. However, duodenal biopsies are mandatory if the optical coherence tomography shows normal villous morphology in patients with positive antibodies.",
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