Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers

Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.
BMC Gastroenterology (Impact Factor: 2.37). 02/2009; 9(1):19. DOI: 10.1186/1471-230X-9-19
Source: PubMed


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

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Available from: Jonas Ludvigsson, Mar 05, 2014
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    • "Through the personal identity number [30] we linked data on smoking and moist snuff use obtained from some Swedish construction workers [31,32], with data on CD from Sweden’s 28 pathology departments [33]. "
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    ABSTRACT: Background Smoking status has been linked to several chronic inflammatory conditions but earlier research on smoking and celiac disease (CD) is contradictive. There are little data on moist snuff use and CD. The purpose of this study was to investigate the association between smoking, moist snuff use and later CD. Methods We identified individuals with biopsy-verified CD (villous atrophy, histopathology stage Marsh III) through biopsy-reports from Sweden’s 28 pathology departments. Data on smoking and moist snuff were collected from the Swedish construction worker database “Bygghälsan” that includes preventive health care check-up data. Through poisson regression we calculated relative risks (RRs) for later CD according to smoking status (n = 305,722), and moist snuff status (n = 199,200) adjusting for age, sex and decade. Results During follow-up 488 individuals with smoking data, and 310 with moist snuff data had a diagnosis of CD. The risk of CD was independent of smoking status with all RRs being statistically insignificant and ranging between 0.9 and 1.0. Compared to non-smokers, neither current smokers (RR = 0.93; 95% CI = 0.76-1.14) nor ex-smokers (RR = 0.98; 95% CI = 0.75-1.28) were at increased or decreased risk of CD. Risk estimates were similar in moderate smokers (RR = 0.92; 0.72-1.16) and heavy smokers (RR = 0.95; 0.74-1.24), and did not change when we examined the risk more than ten years after health examination (RR-moderate: 0.90; and RR-heavy: 0.95; both p > 0.05). Moist snuff use was not associated with later CD (RR = 1.00; 0.78-1.28), or with CD after more than ten years of follow-up (RR = 1.05; 0.80-1.38). Conclusions We found no association between smoking, moist snuff use and future CD.
    BMC Gastroenterology 07/2014; 14(1):120. DOI:10.1186/1471-230X-14-120 · 2.37 Impact Factor
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    • "Although in some cases visual information provided by WCE are sufficient for identifying GI lesions [7] [8] [9], this technique lacks the ability of collecting biopsy samples, which is crucial for an effective and definitive diagnosis [10]. In particular, random biopsies of small bowel tissue are required to diagnose celiac disease, malabsorption syndromes, food sensitivity, autoimmune disease, inflammatory small bowel disease, and small bowel infection [11]. "
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    ABSTRACT: The authors present a novel magneto-mechanical elastic element that can be loaded remotely by varying the magnetic field surrounding it and that is able to store and release mechanical energy upon external triggering. The Magnetic Torsion Spring (MTS) is used as the core component of a self-contained miniature biopsy capsule (9 mm in diameter and 24 mm long) for random tissue sampling in the small bowel. Thanks to the MTS concept, the biopsy mechanism can be loaded wirelessly by a magnetic field applied from outside the body of the patient. At the same time, magnetic coupling guarantees stabilization against the small bowel tissue during sampling. Extreme miniaturization is possible with the proposed approach, since no electronics and no power supply are required on-board.
    Journal of Medical Devices 12/2013; 7(1):1-9. DOI:10.1115/1.4025185 · 0.42 Impact Factor
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    • "In brief, between October 2006 and February 2008, computerized biopsy reports from these pathology departments were queried for villous atrophy via SnoMed classification codes and, using the unique Patient Identification Number (PIN), these patients were linked to the Swedish Total Population Register [17]. A validation study involving detailed chart review of patients with villous atrophy demonstrated that this querying method identified patients with CD with a positive predictive value of 95% [16]. Each patient with CD was then matched via Statistics Sweden by age, gender, calendar period, and county with up to five control patients without CD. "
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    ABSTRACT: The prevalence of celiac disease and the use of medications that inhibit acid secretion have both increased in recent decades. To explore the association between antisecretory medication exposure and subsequent development of celiac disease. In this population-based case control study, we identified patients with celiac disease diagnosed at all pathology departments in Sweden from July 2005 through February 2008. Patients were matched by age and gender with up to 5 controls. We identified prior prescriptions for proton pump inhibitors and histamine-2 receptor antagonists in all subjects. We used conditional logistic regression to measure the association between these prescriptions and the subsequent diagnosis of celiac disease. Prior proton pump inhibitor prescription was strongly associated with celiac disease (OR 4.79; 95% CI 4.17-5.51). Patients prescribed both proton pump inhibitors and histamine-2 receptor antagonists had a higher risk of celiac disease (OR 5.96; 95% CI 3.58-9.91) than those prescribed proton pump inhibitors alone (OR 4.91; 95% CI 4.26-5.66) or histamine-2 receptor antagonists alone (OR 4.16; 95% CI 2.89-5.99). Exposure to antisecretory medications is associated with a subsequent diagnosis of celiac disease. The persistence of this association after excluding prescriptions in the year preceding the celiac disease diagnosis suggests a causal relationship.
    Digestive and Liver Disease 09/2013; 46(1). DOI:10.1016/j.dld.2013.08.128 · 2.96 Impact Factor
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