ABSTRACT
Introduction: Celiac disease (CD) is a chronic gluten related autoimmune disease, whose suspicion is based on clinical manifestations, positive autoantibodies, concordant genetics together with a confirmatory biopsy. According to the ESPGHAN guidelines patients could avoid endoscopy, for the diagnosis in Argentina the no-biopsy approach is not supported by local health regulations. Since March 2020 when the WHO declared the Sars Cov 2 pandemia a strict quarantine was established in our country with an overall drop in the number of endoscopies. Aim: To compare the number and clinical characteristics of biopsy diagnostic approach of CD one year prior and during pandemia in relation to the total number of upper GI endoscopies (UE) performed during those periods. Material and methods: Observational and analytical study in a retrospective cohort of children under 19 years of age who underwent an UE due to celiac disease suspicion in the following time periods: Group I (GI) pre-pandemia from March 2019 to February 2020 and Group II (GII) during pandemia from March 2020 to February 2021. Inclusion criteria were patients who underwent UE due to CD suspicion with positive antitrasglutaminase antibodies together with adequate duodenal samples to establish Marsh classification. CD diagnosis was confirmed on the basis of positive antitrasglutaminase antibodies and Marsh II or III histology. Results: 45 patients were evaluated, 30 of GI (66%) and 15 of GII (33%). In GI, a total of 397 UE were performed, 30/397 (7.5%) due to suspected CD, the mean age of presentation was 10 years, 22/30 females (73%). While in GII 215 UE were performed, 15/215 (6.9%) for suspected CD, mean age was 7 years, 9/15 were women (60%). The forms of clinical presentation observed vary in both periods as shown in Table 1. Regarding antitransglutaminase, 86% (n26) had positive antibodies in GI and 93% (n14) in GII, with mean values of 981.18 (1.9 - 4965.5) and 1857.17 (146.4 - 4965.5) respectively. As for biopsies, in both periods 80% had a compatible biopsy, while 4 (13%) had a normal biopsy in GI and only 1 (6%) in GII, Marsh 1 in GI 0 vs GII 1, Marsh 2 GI 2 vs GII 0, Marsh 3A GI 1 vs GII 0, Marsh 3B GI 15 vs GII 7, Marsh 3C GI 6 vs GII 5. Conclusion: In this single center cohort experience study in children there were no major differences in the percentage of celiac diagnosis based on biopsy confirmation in relation to the overall endoscopies performed. During COVID pandemia there was an increase in atypical presentations, younger children, higher values of antibodies and a reduction by a half of the total number of cases per year. Moving to a “no biopsy approach” will probably helps skipping new cases related to parents fear in bringing into their child to undergo a procedure.
ABSTRACT
Radiology departments have been directly involved from the beginning of the novel coronavirus disease (COVID-19) emergency to provide imaging lung assessment of suspected and positive patients while ensuring the execution of other routine and emergency examinations for non-COVID-19 patients. To limit the risk of the infection spread, radiology departments should be reconfigured. We propose the example of the reorganization of the Radiology Department of our hospital, in the center of Milan, in Northern Italy, which consisted of the creation of 2 completely distinct pathways and distinct radiological machines for COVID-19 positive or suspected positive and for non-COVID-19 patients.