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World J Methodol. Sep 26, 2014; 4(3): 189-196
Published online Sep 26, 2014. doi: 10.5662/wjm.v4.i3.189
Dyspepsia and celiac disease: Prevalence, diagnostic tools and therapy
Laura Petrarca, Raffaella Nenna, Gerarda Mastrogiorgio, Matteo Florio, Manuela Brighi, Stefano Pontone
Laura Petrarca, Raffaella Nenna, Gerarda Mastrogiorgio, Matteo Florio, Department of Pediatrics, “Sapienza” University of Rome, 00161 Rome, Italy
Manuela Brighi, Stefano Pontone, Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
Author contributions: Petrarca L wrote the first draft; Mastrogiorgio G, Florio M and Brighi M conception and design of the manuscript; Nenna R and Pontone S critical revision of the manuscript for important intellectual content.
Correspondence to: Dr. Stefano Pontone, Department of Surgical Sciences, “Sapienza” University of Rome, V.le Regina Elena n° 324, 00161 Rome, Italy. stefano.pontone@uniroma1.it
Telephone: +39-06-49975503 Fax: +39-06-49975503
Received: April 1, 2014
Revised: June 17, 2014
Accepted: September 6, 2014
Published online: September 26, 2014
Abstract

The prevalence of dyspepsia is up to 40% in population-based study. Functional dyspepsia is an exclusion diagnosis and it is classified as a chronic abdominal pain-related functional disorder, characterized by the presence of persistent or recurrent pain or discomfort centered in the upper abdomen, neither relief by defecation, nor association with the onset of a change in stool frequency or form. Celiac disease (CD) is a common autoimmune enteropathy, with a prevalence around 1% in the general population. Its diagnosis includes a serological screening and an upper gastrointestinal endoscopy with multiple biopsies. Gluten-free diet is the only effective treatment. CD diagnosis is often delayed in asymptomatic patients or in individuals with less clinical gastrointestinal symptoms. Several studies performed coeliac disease screening in patients with symptoms suggestive of dyspepsia, showing a biopsy-proved prevalence that ranged from 0.5% to 2%. The typical endoscopic markers of villous atrophy are not sufficiently sensitive, so some endoscopic techniques, such as “water immersion” and confocal endomicroscopy were proposed to improve the diagnostic sensitivity and target biopsies. A recent meta-analysis estimated that the prevalence of CD was higher in patients with dyspepsia, but not in a statistically significant way. However this assumption should be confirmed further larger studies.

Keywords: Dyspepsia, Coeliac disease, Upper endoscopy, Villus atrophy, Screening

Core tip: Dyspepsia is classified as a chronic abdominal pain-related functional disorder that affects almost 40% of the population. It can be also a manifestation of celiac disease, an immuno-mediated enteropathy, caused by the ingestion of gluten in genetically predisposed patients. The prevalence of celiac disease among dyspeptic patients has been investigated, with results ranging from 0.5% to 2%. Celiac disease diagnosis requires histological evaluation of villous atrophy on duodenal biopsies specimens. Screening for celiac disease in dyspeptic patients and routinely performing of biopsies during upper gastrointestinal endoscopy, may be useful as part of the diagnostic flow-chart of these patients.