Introduction Coeliac disease is a common cause of malabsorption in western countries. The gold standard method of diagnosing coeliac disease is by way of duodenal biopsy. Weight loss is a symptom of malabsorption. Patients referred for upper gastrointestinal endoscopy with symptoms of weight loss commonly undergo duodenal biopsy to assess for presence of coeliac disease. We hypothesis that those patients with weight loss and who routinely have duodenal biopsies very rarely have coeliac disease unless there are other pointers towards malabsorption.
Method A single centre, retrospective analysis of consecutive patients undergoing upper gastrointestinal endoscopy for the sole indication of weight loss was undertaken within a large associate teaching hospital within North London from 2005–2016. Of these patients, we reviewed those that had duodenal (D2) biopsies and the results. If they proved abnormal, we looked back for additional markers of malabsorption, clinically and biochemically.
Results 142 consecutive patients, 65 were Male, 77 were female, underwent OGD for weight loss. Out of this cohort, 62% (n=88) had a duodenal biopsy. 89% (n=78) of these had a normal biopsy. 11% (n=10) had an abnormal biopsy, and 6 of these patients had coeliac, whilst 4 had other pathology such as granulomas or duodenitis.
For all the patients who had abnormal D2 biopsies, they had other clinical markers of malabsorption, such as abdominal pain and diarrhoea, or biochemical indices such as anaemia or elevated TTG antibodies.
Conclusion From this study we conclude, that the yield of routine duodenal biopsies in patients endoscoped for the sole indication of weight loss is poor. In patients with weight loss in whom coeliac disease is identified on biopsy is always associated with additional symptoms or abnormalities in blood indices. We conclude that there is no need to take biopsies of the duodenum on a routine basis for weight loss alone unless there are other signs of malabsorption. This will save time (both from taking the biopsy and sampling in the lab), lower the cost (forceps and pot) and improve the safety (potential perforation and bleeding risk) of the procedure.
Disclosure of Interest None Declared
- Duodenal biopsy
- weight loss
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