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Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers.
BMC Gastroenterol. 2009 Mar 11; 9:19.BG

Abstract

BACKGROUND

Small intestinal biopsy with villous atrophy (VA) is the gold standard for the diagnosis of celiac disease (CD). We validated VA (Marsh 3) and small intestinal inflammation without VA (Marsh 1+2) in Swedish regional biopsy registers.

METHODS

All pathology departments in Sweden (n = 28) were searched to identify individuals with VA or duodenal/jejunal inflammation. The validation consisted of blinded examination of biopsy samples, manual review of biopsy reports, web surveys, and patient chart reviews of 121 individuals with VA and 39 with inflammation.

RESULTS

We identified 29,148 individuals with VA and 13,446 individuals with inflammation. In a blinded examination, Swedish pathologists correctly classified 90% of biopsies with VA. Manual screening of 1,534 biopsy reports (performed by co-author JFL and a research assistant) found that comorbidity other than CD was rare. IBD was the most common comorbidity and occurred in 0.3% of biopsies with VA (1.6% in inflammation). Among 114 patients with VA and available data, 108 (95%) had a clinical diagnosis of CD. 79% of the validated individuals with VA and 64% of those with inflammation had documented gastrointestinal symptoms prior to biopsy. 88% of the validated individuals with VA had positive CD serology before their first biopsy. 172/180 (96%) of Swedish gastroenterologists and 68/68 (100%) of pediatricians perform a small intestinal biopsy in at least 9 out of 10 individuals prior to diagnosis of CD.

CONCLUSION

Regional biopsy data are feasible to identify individuals with CD and small-intestinal inflammation. The specificity of CD is high in villous atrophy.

Authors+Show Affiliations

Department of Pediatrics, Orebro University Hospital, Orebro, Sweden. jonasludvigsson@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

19284576

Citation

Ludvigsson, Jonas F., et al. "Validation Study of Villous Atrophy and Small Intestinal Inflammation in Swedish Biopsy Registers." BMC Gastroenterology, vol. 9, 2009, p. 19.
Ludvigsson JF, Brandt L, Montgomery SM, et al. Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers. BMC Gastroenterol. 2009;9:19.
Ludvigsson, J. F., Brandt, L., Montgomery, S. M., Granath, F., & Ekbom, A. (2009). Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers. BMC Gastroenterology, 9, 19. https://doi.org/10.1186/1471-230X-9-19
Ludvigsson JF, et al. Validation Study of Villous Atrophy and Small Intestinal Inflammation in Swedish Biopsy Registers. BMC Gastroenterol. 2009 Mar 11;9:19. PubMed PMID: 19284576.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers. AU - Ludvigsson,Jonas F, AU - Brandt,Lena, AU - Montgomery,Scott M, AU - Granath,Fredrik, AU - Ekbom,Anders, Y1 - 2009/03/11/ PY - 2008/07/14/received PY - 2009/03/11/accepted PY - 2009/3/17/entrez PY - 2009/3/17/pubmed PY - 2009/5/6/medline SP - 19 EP - 19 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 9 N2 - BACKGROUND: Small intestinal biopsy with villous atrophy (VA) is the gold standard for the diagnosis of celiac disease (CD). We validated VA (Marsh 3) and small intestinal inflammation without VA (Marsh 1+2) in Swedish regional biopsy registers. METHODS: All pathology departments in Sweden (n = 28) were searched to identify individuals with VA or duodenal/jejunal inflammation. The validation consisted of blinded examination of biopsy samples, manual review of biopsy reports, web surveys, and patient chart reviews of 121 individuals with VA and 39 with inflammation. RESULTS: We identified 29,148 individuals with VA and 13,446 individuals with inflammation. In a blinded examination, Swedish pathologists correctly classified 90% of biopsies with VA. Manual screening of 1,534 biopsy reports (performed by co-author JFL and a research assistant) found that comorbidity other than CD was rare. IBD was the most common comorbidity and occurred in 0.3% of biopsies with VA (1.6% in inflammation). Among 114 patients with VA and available data, 108 (95%) had a clinical diagnosis of CD. 79% of the validated individuals with VA and 64% of those with inflammation had documented gastrointestinal symptoms prior to biopsy. 88% of the validated individuals with VA had positive CD serology before their first biopsy. 172/180 (96%) of Swedish gastroenterologists and 68/68 (100%) of pediatricians perform a small intestinal biopsy in at least 9 out of 10 individuals prior to diagnosis of CD. CONCLUSION: Regional biopsy data are feasible to identify individuals with CD and small-intestinal inflammation. The specificity of CD is high in villous atrophy. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/19284576/Validation_study_of_villous_atrophy_and_small_intestinal_inflammation_in_Swedish_biopsy_registers_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-9-19 DB - PRIME DP - Unbound Medicine ER -