Red Spot Lesions in the Duodenal Bulb are a Highly Specific Endoscopic Sign of Celiac Disease: A Prospective Study

We have recognized Red Spot Lesions (RSLs) in the duodenal bulb in children with celiac disease (CD) and believe they may represent an underappreciated and distinct endoscopic sign of CD. A total of 171 pediatric patients undergoing esophagogastroduodenoscopy with duodenal biopsy for symptoms consistent with CD were prospectively recruited. There were 75 patients who met criteria for CD and the remaining 96 patients served as symptomatic controls. As compared to endoscopic markers frequently mentioned in literature, RSLs had comparable sensitivity, specificity, positive predictive value, and negative predictive value of 31%, 94%, 80%, and 64%, respectively. If RSLs are noted during endoscopy in a patient with gastrointestinal symptoms that might be the result of CD, then sufficient duodenal biopsies to make the diagnosis of CD should be obtained. Address correspondence and reprint requests to Jocelyn A. Silvester, MD PhD, Boston Children's Hospital, Hunnewell Ground, 300 Longwood Avenue, Boston, MA 02115 (e-mail: Jocelyn.Silvester@childrens.harvard.edu) Received 19 December, 2017 Accepted 11 September, 2018 Author Contributions: Conception and design of study: AML, EAF; Data acquisition: EAF, JDG, AK, AML, CEM, DCW; Analysis and interpretation of data: EAF, JDG, AML, PDM, JAS, DCW. Drafting manuscript: EAF, AML, JAS, ZJH. All authors critically reviewed and approved the final version of the manuscript. Source of Funding: This research was supported by Boston Children's Hospital. Jocelyn A. Silvester, MD is supported by NIH/NIDDK T32 DK 07760. All other authors report no financial disclosures. Conflict of Interest: The authors declare no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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