The Role of Duodenal Red Spot Lesions in Screening and Diagnosing Pediatric Celiac Disease

Abstract

Background: Celiac disease is an autoimmune enteropathy diagnosed through histopathological studies and serologic tests. However, in children, these criteria are not always met. Red spot lesions (RSLs), a rare endoscopic finding, may be associated with celiac disease. Objectives: This study aimed to evaluate the presence of RSLs as a diagnostic indicator in celiac disease and to measure the sensitivity and specificity of such lesions in the diagnosis of this disease. Methods: This observational diagnostic study, conducted over 36 months in a tertiary pediatric hospital in Tehran, Iran, included 302 children under the age of 18. These children, who were candidates for duodenal biopsy and endoscopy, were selected based on clinical presentations and serologic results indicative of celiac disease. Participants were divided into two groups according to their pathological results: The celiac group (25 cases) and the control group (277 cases). The index test was the endoscopic identification of RSLs in the duodenal bulb under narrow-band imaging (NBI), assessed in real time and independently confirmed by a second, blinded pediatric gastroenterologist via recorded video. The reference standard was a celiac disease diagnosis based on duodenal biopsy histopathology (Marsh ≥ II) interpreted by a blinded expert pathologist, combined with positive anti-tTG IgA serology and normal total IgA levels, as per European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. Sensitivity, specificity, predictive values, and likelihood ratios (LRs) were calculated. Results: A total of 302 patients (46.35% male) with an average age of 8.29 ± 4.27 years were included in our research study. The agreement rate between two gastroenterologists in identifying RSLs was reported to be over 90%. The RSLs were present in 60% of the definite group and 8.30% of the potential group. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and positive and negative LRs of RSLs for diagnosing celiac disease were 60%, 91.6%, 39.4%, 96.2%, 6.43, and 0.43, respectively. Conclusions: The presence of RSLs during endoscopy in patients with gastrointestinal symptoms and positive serologic tests could be indicative of celiac disease. However, the utility of RSLs as a screening tool warrants further investigation.