Value of duodenal endoscopic markers of villous atrophy

Several endoscopic aspects of duodenal mucosa have been described in patients with villous atrophy [VA] and celiac disease. We assessed the accuracy of three endoscopic markers in patients referred for duodenal biopsy.methods: From January 1992 to June 2000 all patients undergoing upper gastrointestinal [UGI] endoscopy by a single operator [n = 4102], had the second part of the duodenum examined, without any magnification technique or addition of vital dye staining, for the presence of three markers of VA, [1] reduction or loss of Kerkring's folds, [2] scalloped configuration of the duodenal folds, and [3] mosaic appearance of the mucosa.Biopsy samples were taken from those in whom the mucosa was abnormal [n = 51], and from those in whom it Was normal but where biopsy was indicated [n = 230].None of the 230 endoscopically normal controls had VA. Seven out of 51 patients [14%] with an abnormal mucosa had a normal histology, the remaining 44 [86%] had some degree of VA confirmed at histology, partial VA in 11 patients [25%] and subtotal or total VA in 33 patients [75%]. 63% of the patients with only one endoscopic marker had VA confirmed at histology whereas the coexistence of more than one marker was always associated with histological villous atroluphy. The overall sensitivity, specificity, positive and negative predictive values of the endoscopic markers were respectively, 100%, 97%, 86%, and 100%.mg 44 [86%] had some degree of VA confirmed at histology, partial VA in 11 patients [25%] and subtotal or total VA in 33 patients [75%]. 63% of the patients with only one endoscopic marker had VA confirmed at histology whereas the coexistence of more than one marker was always associated with histological villous atrophy. The overall sensitivity, specificity, positive and negative predictive values of the endoscopic markers were respectively, 100%, The appearance of the second part of the duodenal mucosa as assessed during routine UGI endoscopy, is a sensitive and specific indicator of the presence of VA on biopsy, and should alert the endoscopist to the possibility of a celiac disease

Prevalence of malnutrition in general surgical patients

The possibility of protein calorie malnutrition [PCM] was studied on one hundred consecutive patients admitted to the department of surgery at the Saint Georges hospital, Beirut, during the months of April and June 1991, regardless of age, sex and socio economic status. Data was completed on 94 of those cases. Multiple parameters were studied, including measurements of triceps and subscapular skinfold thickness, mid arm muscle circumference, percent weight loss, creatinine height index, serum albumin and transferring levels and total lymphocyte count. We found a prevalence of 81%, 65%, 53% and 31% of PCM, if one, two, three or at least four abnormal parameters are used respectively, to assess malnutrition. Defining malnutrition as the presence of at least three abnormal parameters, we conclude that 53% of the patients, on admission to the department of surgery, had evidence of PCM. Further studies are required to assess the impact of this prevalence on length of stay, morbidity and mortality