A Key Role for Abdominal Ultrasound Examination in ”Difficult” Diagnoses of Celiac Disease

Zusammenfassung

Ziel: Untersuchung der Wertigkeit des abdominalen Ultraschalls (US) in der diagnostischen Abklärung von Patienten mit Verdacht auf Zöliakie (CD) mit negativen Serum-Antikörpern und unklarer Diagnose. Material und Methoden: 524 konsekutive Patienten mit für die CD-typischen Symptomen erhielten eine umfangreiche diagnostische Abklärung. 76 (14 %) wurden wegen positiver Serum-Anti-tTG und/oder EmA-Antikörpern ausgeschlossen. Weitere 377 Patienten wurden ausgeschlossen, da bei ihnen eine andere Diagnose als CD gestellt wurde oder sie HLA-DQ2- oder DQ 8-negativ waren. Bei 71 Patienten war die Diagnose einer seronegativen CD wahrscheinlich, diese erhielten eine abdominale US-Untersuchung und eine Duodenum-Biopsie zur histologischen Untersuchung. Ergebnisse: Die intestinale histologische Untersuchung und der folgende klinische und histologische Verlauf bestätigte die Diagnose einer CD bei 12 Patienten (Gruppe 1) und schloss sie bei 59 Patienten aus (Gruppe 2). Im abdominalen Ultraschall hatte das Vorhandensein dilatierter Darmschlingen und verdickter Dünndarmwände eine Sensitivität von 83 % und einen negativ prädiktiven Wert (NPV) von 95 % für die Diagnose einer CD. Zudem hatten 11 / 12 seronegativen CD-Patienten mindestens einen der zwei Ultraschall-Marker. Bei Berücksichtigung nur eines dieser zwei Ultraschall-Marker erhöhte sich die Sensitivität des abdominalen US auf 92 % und der NPV auf 98 %. Schlussfolgerung: Abdominaler US erweist sich in der diagnostischen Abklärung von Patienten mit hochgradigem CD-Verdacht und Seronegativität als wertvolle Untersuchungsmethode.

Abstract

Purpose: To evaluate the usefulness of abdominal ultrasound examination (US) for the diagnostic workup of cases of suspected CD involving negative serum antibodies and difficult diagnosis. Materials and Methods: 524 consecutive patients with symptoms of suspected CD underwent an extensive diagnostic workup. 76 (14 %) were excluded since they were positive for serum anti-tTG and/or EmA antibodies. 377 were excluded since they were diagnosed with something other than CD or did not have the alleles encoding for HLA DQ 2 or DQ 8. A diagnosis of CD with negative serum antibodies was probable in 71 patients who underwent abdominal US and duodenal biopsy for histology evaluation. Results: Intestinal histology and subsequent clinical and histological follow-up confirmed the CD diagnosis in 12 patients (GROUP 1) and excluded it in 59 subjects (GROUP 2). Abdominal US showed that the presence of dilated bowel loops and a thickened small bowel wall had a sensitivity of 83 % and a negative predictive value (NPV) of 95 % in CD diagnosis. Furthermore, in 11 of the 12 CD seronegative patients there was at least one of these two abdominal US signs. Therefore, considering the presence of one of these two signs, abdominal US sensitivity increased to 92 % and NPV to 98 %. Conclusion: Abdominal US is useful in the diagnostic workup of patients with a high clinical suspicion of CD but with negative serology.

Key words

celiac disease - ultrasound - sensitivity - specificity - serology

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