ORIGINAL ARTICLE
The role of antral histopathology in diagnosing paediatric celiac disease
1
Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
2
Children and Adolescent Health Research Centre, Drug Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
3
Paediatric Gastroenterology and Hepatology Research Centre, Zabol University of Medical Sciences, Zabol, Iran
Submission date: 2023-08-18
Final revision date: 2023-10-05
Acceptance date: 2023-11-15
Publication date: 2024-02-01
Pol J Pathol 2023;74(4):256-264
KEYWORDS
TOPICS
ABSTRACT
The aim of this study was to evaluate the diagnostic potential of gastric antrum histology in children suspected of having celiac disease (CD).
The present retrospective study was performed on 224 patients who were suspected of having CD and had several duodenal and one gastric antrum biopsies. They were divided into 2 groups based on the definite diagnosis of CD. The statistical analysis was performed using SPSS version 22 software. Receiver operating characteristic (ROC) curves were drown and the area under the curves (AUCs) was calculated.
Article authorized by the Editor-in-Chief.
Based on MARSH criteria, out of 224 patients, 124 were diagnosed as definite CD and 100 patients comprised the non-celiac group. The AUC for the mean of all pathological tests was estimated to be 0.90 (p < 0.001). The pooled AUC for the combination of 3 pathologic findings with the highest AUCs (cell, crypt, and gland size) was estimated to be 0.89 (p < 0.001).
We observed that the histological changes we found in the gastric antrum were identical to those found in the duodenum of paediatric CD patients. Because providing a biopsy from the gastric antrum is easier than getting multiple biopsies from the duodenum, we suggest using the criteria mentioned in this study in other studies with larger sample sizes.
The present retrospective study was performed on 224 patients who were suspected of having CD and had several duodenal and one gastric antrum biopsies. They were divided into 2 groups based on the definite diagnosis of CD. The statistical analysis was performed using SPSS version 22 software. Receiver operating characteristic (ROC) curves were drown and the area under the curves (AUCs) was calculated.
Article authorized by the Editor-in-Chief.
Based on MARSH criteria, out of 224 patients, 124 were diagnosed as definite CD and 100 patients comprised the non-celiac group. The AUC for the mean of all pathological tests was estimated to be 0.90 (p < 0.001). The pooled AUC for the combination of 3 pathologic findings with the highest AUCs (cell, crypt, and gland size) was estimated to be 0.89 (p < 0.001).
We observed that the histological changes we found in the gastric antrum were identical to those found in the duodenum of paediatric CD patients. Because providing a biopsy from the gastric antrum is easier than getting multiple biopsies from the duodenum, we suggest using the criteria mentioned in this study in other studies with larger sample sizes.
REFERENCES (30)
1.
Noori NM, Khalili M, Shahramian I, Teimouri A. Evaluation of aortic elasticity in children with celiac disease compared with controls. Int J Pediatr 2020; 9: 13817-13832.
2.
Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018; 16: 823-36.e2.
3.
Graczyk J, Makowska O, £ê¿yk-Ciemniak E, Szaflarska-Pop³aw- ska A, Krogulska A. Celiac disease and ulcerative colitis as comorbid diseases – the diagnostic challenge. Pediatr Pol 2022; 97: 356-361.
4.
Myléus A, Ivarsson A, Webb C, et al. Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic. J Pediatr Gastroenterol Nutr 2009; 49: 170-176.
5.
Ensari A. Gluten-sensitive enteropathy (celiac disease): controversies in diagnosis and classification. Arch Pathol Lab Med 2010; 134: 826-836.
6.
Kelly CP, Bai JC, Liu E, Leffler DA. Advances in diagnosis and management of celiac disease. Gastroenterology 2015; 148: 1175-1186.
7.
Popp A, Kivelä L, Fuchs V, Kurppa K. Diagnosing celiac disease: towards wide-scale screening and serology-based criteria? Gastroenterol Res Pract 2019; 2019: 2916024.
8.
Lebwohl B, Kapel RC, Neugut AI, Green PH, Genta RM. Adherence to biopsy guidelines increases celiac disease diagnosis. Gastrointestinal Endoscopy 2011; 74: 103-109.
9.
Drut R, Drut RM. Lymphocytic gastritis in pediatric celiac disease–immunohistochemical study of the intraepithelial lymphocytic component. Med Sci Monitor 2004; 10: CR38-CR42.
10.
Gabrieli D, Ciccone F, Capannolo A, et al. Subtypes of chronic gastritis in patients with celiac disease before and after gluten- free diet. United European Gastroenterol J 2017; 5: 805-810.
11.
Bhatti TR, Jatla M, Verma R, Bierly P, Russo PA, Ruchelli ED. Lymphocytic gastritis in pediatric celiac disease. Pediatr Develop Pathol 2011; 14: 280-283.
12.
Lebwohl B, Green PH, Genta RM. The coeliac stomach: gastritis in patients with coeliac disease. Aliment Pharmacol Ther 2015; 42: 180-187.
13.
Marsh MN. Gluten, major histocompatibility complex, and the small intestine: a molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 1992; 102: 330-354.
14.
Marsh MN, Johnson MW, Rostami K. Mucosal histopathology in celiac disease: a rebuttal of Oberhuber’s sub-division of Marsh III. Gastroenterol Hepatol Bed Bench 2015; 8: 99-109.
15.
Heidari Z, Mahmoudzadeh-Sagheb H, Moudi B. A quantitative study of sodium tungstate protective effect on pancreatic beta cells in streptozotocin-induced diabetic rats. Micron 2008; 39: 1300-1305.
16.
Heidari Z, Mahmoudzadeh-Sagheb H, Sheibak N, Nourzaei N. Quantitative changes of extravillous trophoblast cells in placentas of systemic lupus erythematosus patients. J Obstet Gynaecol 2017; 37: 746-751.
17.
Heidari Z, Sakhavar N, Mahmoudzadeh-Sagheb H, Ezazi- Bojnourdi T. Stereological analysis of human placenta in cases of placenta previa in comparison with normally implanted controls. J Reprod Infertil 2015; 16: 90-95.
18.
Alsaigh N, Odze R, Goldman H, Antonioli D, Ott MJ, Leichtner A. Gastric and esophageal intraepithelial lymphocytes in pediatric celiac disease. Am J Surg Pathol 1996; 20: 865-870.
19.
Hayat M, Arora D, Wyatt J, O’mahony S, Dixon M. The pattern of involvement of the gastric mucosa in lymphocytic gastritis is predictive of the presence of duodenal pathology. J Clin Pathol 1999; 52: 815-819.
20.
Prasad KK, Thapa BR, Lal S, Sharma AK, Nain CK, Singh K. Lymphocytic gastritis and celiac disease in Indian children: evidence of a positive relation. J Pediatr Gastroenterol Nutr 2008; 47: 568-572.
21.
Marsilio I, Maddalo G, Ghisa M, Savarino EV, Farinati F, Zingone F. The coeliac stomach: a review of the literature. Digest Liver Dis 2020; 52: 615-624.
22.
Pastore L, Carroccio A, Compilato D, Panzarella V, Serpico R, Muzio LL. Oral manifestations of celiac disease. J Clin Gastroenterol 2008; 42: 224-232.
23.
Casella G, Villanacci V, Di-Bella C, et al. Colonoscopic findings in coeliac disease on a gluten-free diet. Rev Esp Enferm Dig 2010; 102: 538-541.
24.
Judd LM, Gleeson PA, Toh BH, van Driel IR. Autoimmune gastritis results in disruption of gastric epithelial cell development. Am J Physiol 1999; 277: G209-G218.
25.
MacDonald TT. Epithelial proliferation in response to gastrointestinal inflammation. Ann N Y Acad Sci 1992; 664: 202-209.
26.
Savidge T, Walker-Smith J, Phillips A, Savidge T. Intestinal proliferation in coeliac disease: looking into the crypt. Gut 1995; 36: 321-323.
27.
Barone MV, Caputo I, Ribecco MT, et al. Humoral immune response to tissue transglutaminase is related to epithelial cell proliferation in celiac disease. Gastroenterology 2007; 132: 1245-1253.
28.
Gundemir S, Colak G, Tucholski J, Johnson GV. Transglutaminase 2: a molecular Swiss army knife. Biochim Biophys Acta 2012; 1823: 406-419.
29.
Yu XB, Uhde M, Green PH, Alaedini A. Autoantibodies in the extraintestinal manifestations of celiac disease. Nutrients 2018; 10: 1123.
30.
Odze RD, Goldblum JR. Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas. 2nd ed. Philadelphia, PA: Saunders Elsevier; 2009.
Share
RELATED ARTICLE
| eISSN: | 2084-9869 |
| ISSN: | 1233-9687 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
