gluten associated dyspepsia; serology and histological characteristics

aim : the aim of this study was to discuss the prevalence of celiac disease (cd) in dyspeptic patients. background : although severe mucosal abnormality with villous atrophy (lesions marsh iii) is at present the gold standard for the diagnosis of cd, presentation with non-specific microenteropathy (marsh i-ii) with positive serology is also common. patients with dyspepsia, specific cd antibodies and microenteropathy, could have cd. patients and methods : from november 2007 to october 2008, 407 patients who randomly 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 celiac disease 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. 4 patients (0.98%) were iga deficient and none of them were positive for igg ttg. serology showed a positive result for ttga in 33/407 (8%) and only 10 of them (2.5%) had abnormal histology (marsh i-iiic). conclusion : mildly positive autoantibodies similar to milder enteropathy (marsh 0-ii) have a low specificity for cd. the prevalence of cd among symptomatic dyspeptic individuals was high hence dyspepsia should be considered as a cardinal sign for cd.