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Scalloping is a reliable endoscopic marker for celiac disease
Author(s) -
Kasirer Yair,
Turner Dan,
Lerman Leora,
Schechter Abraham,
Waxman Jacob,
Dayan Bosmat,
Bergwerk Ari,
Rachman Yelena,
Freier Zerem,
Silbermintz Ari
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12130
Subject(s) - medicine , esophagogastroduodenoscopy , gastroenterology , histopathology , postprandial , serology , disease , tissue transglutaminase , pathology , endoscopy , immunology , antibody , biochemistry , chemistry , insulin , enzyme
Background Scalloping of duodenal folds noted on esophagogastroduodenoscopy ( EGD ) has been associated with various illnesses including celiac disease ( CD ). The aim of the present study was to examine the frequency of scalloping in pediatric patients undergoing EGD and to assess its significance in the diagnosis of CD . We also evaluated the association of scalloping with the histopathology and celiac serology in the subgroup of celiac patients. Patients and Methods All children (0–18 years) who underwent EGD at S haare Z edek M edical C enter for any reason during a 2.5‐year period were retrospectively included, yielding a consecutive cohort without selection bias. Relevant data were obtained from the patient files. Results During the study period, 623 children underwent EGD of whom 149 (24%) were eventually diagnosed with CD . In 74/623children (12%), scalloping was seen and had a sensitivity of 48% (95% CI 0.40–0.57), specificity of 99% (0.98–0.99) and positive predictive value of 97% (0.9–0.99) to diagnose CD . The prevalence of scalloping increased with advancing stage of the M arsh classification from 33% ( 7 /21) in M arsh 1 to 63% (34/54) in M arsh 3c ( P < 0.001). Scalloping was associated with a significantly higher median tissue transglutaminase level (153 [ IQR 98–168] versus 49 [ IQR 11–143]; P = 0.011). Conclusion The results suggest that the diagnosis of CD is almost certain if isolated scalloping is observed during EGD done to rule out CD . Thus, attention to this finding may serve as an additional tool in the diagnosis of CD .