Contribuição dos aspectos endoscópicos e do estudo histológico das biópsias duodenais, obtidas por esofagogastroduodenoscopia, no diagnóstico da doença celíaca

Abstract

Celiac disease (CD) is a chronic inflammatory disorder of the small intestine after ingestion of gluten in individuals with a certain genetic background. Clinical presentation is extremely changeable and the diagnosis relies on clinicopathologic studies, including serologic tests, mucosal intestinal biopsy and clinic and serologic response to a gluten-free diet. This study was carried out with de propose to make a descriptive analysis of the clinical, endoscopic and histological aspects of patients with clinical and/or serological suspicion of CD in a not probabilistic sample of 80 patients, in the Belo Horizonte city, Brazil. It was also looked to evaluate the interobserver agreement about the histological evaluation of the duodenal biopsies by three independent and masked pathologists. The work was carried through in the Digestive Endoscopy Unity and Pathological Anatomy and Legal Medicine Department of the Clinics Hospital and the College of Medicine of the Federal University of Minas Gerais. The symptoms of the patients were very changeable, with prominence for the chronic diarrhea, present in 48 (60%) patients. At least one serologic test was carried through in 51 (63.75%) patients. The endoscopic aspects related with the duodenal villous atrophy had been observed in 32 (40%) patients, with prominence for the visible submucosal vessels and the loss or decrease of duodenal folds. After the evaluation of the intestinal biopsies, there were confirmed 46 cases of CD, with prevalence of 57.5%. The sensitivity, specificity, positive predictive value and negative predictive value of the endoscopics markers for CD diagnosis were of 60.86%, 88.23%, 87.5% and 62.5%, respectively. The pathologists had considered the histological material of good quality and there was moderate interobserver agreement, with similar results using the Marsh-Oberhuber and the Corazza and Villanacci classification systems, with Kappa values of 0.46 and 0.51, respectively. The patients had presented excellent tolerance to the accomplishment of the esophagogastroduodenoscopy and biopsies, with no immediate or delayed complications. In conclusion, the clinical symptoms and laboratorial aspects associated with celiac disease were so changeable and the endoscopic markers of villous atrophy, although not diagnostic, had assisted in the suspicion and indication of the duodenal biopsies, for diagnosis proposal.