Small Intestinal Mucosal Biopsies for Case-Finding in Celiac Disease

A number of studies have explored the role of different serological methods along with endoscopic biopsies for celiac disease population screening as well as case finding in clinical practice. Serological testing with quantitative assays is highly sensitive with a positive predictive value for strongly positive levels of tissue transglutaminase antibodies approaching 80% or more. In a recent comparative study, endoscopic biopsies were reported to have a positive predictive value up to 100% and appear to be especially valuable in selected groups with key symptoms, including diarrhea, weight loss and anemia. Overall, studies have suggested that celiac disease occurs in about 1% of the population in some nations of Europe and the . However, in some symptomatic patients referred for endoscopic evaluation, added duodenal biopsy is a critical investigative tool that, in many instances, has been underutilized as a case-finding tool. Some long-term studies have also suggested that detection of celiac disease has increased, possibly due to better awareness and recognition. Others believe that a recent increase in the disease per se may have occurred, possibly related to environmental factors, including newly developed pharmacologic or biologic agents.