From the Guidelines
Endoscopy with biopsy is recommended for children with positive antibodies for celiac disease, as it provides a definitive diagnosis and guides management. This approach is supported by the standards of medical care in diabetes, which suggest considering referral to a gastroenterologist for evaluation with possible endoscopy and biopsy for confirmation of celiac disease in asymptomatic children with positive antibodies 1. The procedure involves taking multiple biopsies from the duodenum to look for characteristic intestinal damage such as villous atrophy.
Key Points to Consider
- The gold standard for diagnosis of celiac disease is endoscopy with small intestinal biopsies, which should be performed before starting a gluten-free diet.
- Multiple biopsies (at least 4-6) should be taken from the duodenum, including the duodenal bulb, to look for characteristic intestinal damage.
- The procedure is typically performed under sedation or anesthesia to ensure patient comfort.
- Biopsy results, when combined with positive celiac-specific antibody tests and genetic testing, provide the most definitive diagnosis.
- Proper diagnosis through endoscopy is crucial as it confirms the need for lifelong gluten-free diet management, which prevents long-term complications such as growth failure, osteoporosis, and increased risk of certain cancers.
Importance of Accurate Diagnosis
Accurate diagnosis of celiac disease is essential to prevent long-term complications and ensure proper management. While blood tests are useful for screening, they can sometimes yield false positives or negatives. Therefore, endoscopy with biopsy is necessary to confirm the diagnosis and guide treatment. In the context of celiac disease diagnosis, the evidence from 1 is more relevant and recent compared to 1, which focuses on inflammatory bowel disease. Therefore, the recommendation is based on the highest quality and most recent study available, which is 1.
From the Research
Diagnosis and Treatment of Celiac Disease in Children
- Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals 2.
- The Celiac Disease Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommends that children and adolescents with symptoms of celiac disease or an increased risk for celiac disease have a blood test for antibody to tissue transglutaminase (TTG) 2.
- Those with an elevated TTG should be referred to a pediatric gastroenterologist for an intestinal biopsy, and those with the characteristics of celiac disease on intestinal histopathology should be treated with a strict gluten-free diet 2.
Role of Endoscopy in Diagnosing Celiac Disease
- Histologic changes in celiac disease may be patchy or confined to the bulb, and present guidelines recommend obtaining multiple biopsies from the bulb and distal duodenum when evaluating for celiac disease 3.
- A study found that pediatric gastroenterologists generally obtain the recommended number of biopsies in children with histologically confirmed celiac disease, but seldom document biopsies from the bulb 3.
- Another study suggested that examining 4 biopsy samples from the duodenal bulb and 4 from the descending duodenum can improve diagnostic accuracy of celiac disease 4.
Recommendations for Endoscopy in Children with Celiac Disease
- Based on the available evidence, it is recommended that children with celiac disease undergo endoscopy with multiple biopsies from the bulb and distal duodenum to confirm the diagnosis and assess the extent of intestinal damage 2, 3, 4.
- The use of endoscopy and biopsy can help identify children with celiac disease who may require closer monitoring and treatment to prevent long-term complications 2, 3, 4.