Objective: The aim of this study was to determine the prevalence of duodenal villous atrophy (VA) among patients undergoing routine upper gastrointestinal (GI) endoscopy and the value of endoscopic markers for VA in selecting patients for duodenal biopsy.
Methods: One hundred and fifty adult patients with upper GI symptoms or iron-deficiency anemia had inspection and biopsy of the second part of the duodenum during endoscopy. Endoscopic markers for VA sought were mosaic or nodular mucosa, scalloping of duodenal folds, and reduction in number or absence of duodenal folds.
Results: Endoscopic markers were seen in seven patients (5%): scalloped folds with mosaic pattern mucosa (three patients), scalloped folds, reduced in number with mosaic pattern mucosa (three patients), and nodular mucosa with reduction in fold numbers (one patient). All seven patients had partial, subtotal, or total VA. One of 143 patients with no endoscopic abnormality had patchy VA. The prevalence of VA was thus 1:19 (8 of 150). Endoscopic markers had a sensitivity of 87.5% (7 of 8), specificity of 100% (142 of 142), positive predictive value of 100% (7 of 7), and negative predictive value of 99% (142 of 143). Of the eight patients with VA, the indications for endoscopy were upper GI symptoms in seven patients (two with anemia) and anemia without GI symptoms in one. After 6 months of dietary gluten exclusion, improvement by at least one criterion was documented in all eight patients.
Conclusions: Careful inspection of the duodenum during routine upper GI endoscopy allows accurate selection of patients for biopsy but may not detect patchy VA or milder enteropathy. Celiac disease should be considered as a cause of dyspeptic and reflux symptoms, as well as of iron-deficiency anemia.