Ultrasonographic assessment of celiac disease in children: Comparison with antiendomysium antibodies and histology

Several attempts have been made to identify accurate screening tests for celiac disease (CID) with the aim to reduce the need for biopsy or obtaining appropriate selection criteria prior to intestinal biopsy. In this context we evaluated the usefulness of screening for endomysial antibodies (EMA) in the diagnosis of CD in children in comparison with CD-related changes detected by ultrasound (US) or biopsy. Patients: We studied 35 children (1-15 years, 22 girls and 13 boys, mean age 8 years) with untreated CD (N = 15), treated CD (N = 10) and controls (N = 10), undergoing small bowel biopsy as a diagnostic procedure. Methods: US of the small bowel was performed prior to mucosa biopsy using a 4- or 7-MHz transducer of a computed sonography device. The thickness of the intestinal wall and small bowel motility were recorded. Simultaneously, all children had serum routinely sampled for IgA EMA. Results: All controls had histologically normal small bowel mucosa, US showed a small bowel wall thickness of 1 mm with normal motility in 9 children and non-specific wall changes in 1 child. EMA was weakly positive in 1 of these, and negative in all other controls. Of 15 children with untreated CD, severe enteropathy and strongly positive EMA were found in 10 cases; in 5 children moderate enteropathy and positive EMA were detected. Severe US changes were found in all of these children (1.6 mm thickness of the intestinal wall, hyperperistalsis and abundant fluid in the bowel). Mild enteropathy was found in 10 children with treated CD (3 months of a gluten-free diet). EMA was positive in 2 children and weakly positive in 8. Non-specific US changes were found in 6 children. In conclusion, our results indicate that US provides valuable information on small-bowel wall structure and can help in decision making on the necessity of small bowel biopsy. The present study confirms a stronger correlation between EMA and CD than between US and CD.