Gluten associated dyspepsia; serology and histological characteristics

Aim: The aim of this study was to assess the prevalence of celiac disease (CD) in dyspeptic patients. Background: Although severe mucosal abnormality with villous atrophy (lesions Marsh III) is the gold standard for the diagnosis of CD, non-specific microenteropathy (Marsh I-II) with positive serology is also common in patients with dyspepsia. Patients and methods: From November 2007 to October 2008, 407 randomly chosen patients who underwent diagnostic upper gastrointestinal endoscopy for dyspeptic symptoms (193 male, 214 women; mean age 36.1 years) were studied. Small bowel biopsies were performed in all of them. Histologic characteristics in duodenal biopsy specimens for CD were evaluated according to the modified Marsh classification. All the patients were also tested for serum total immunoglobulin A and anti-transglutaminase (tTG) antibodies. Those with IgA deficiency were tested for IgG tTG. Results: Duodenal histology showed Marsh I-IIIc lesions in 6.4% cases. Four patients (0.98%) were IgA deficient and none of them were positive for IgG tTG. Serology showed positive results for tTGA in 8% of the patients and 2.5% of them had abnormal histology (Marsh I-IIIc) compatible with CD. Conclusion: The results of this study showed that milder enteropathy (Marsh 0-II) have a low specificity for CD. The prevalence of CD among dyspeptic individuals is significantly (2.5%) higher than in the general population (1%) and CD should be investigated in these patients.