A final diagnosis of CD was reached in 12 patients (7.4%), 6 men and 6 women aged between 16 and 77 years (mean ± SD, 49 ± 17 years) referred for chronic diarrhea (n = 7/105 [6.7%]), iron deficiency anemia (n = 4/25 [16%]), or dyspepsia (n = 1/32 [3.1%]). All had positive EMA test results and normal total IgA serum levels, and their duodenal lesions were consistent grade III (11 cases) or grade IV (1 case) of the Marsh classification. The results of the duodenal histological evaluation of the 150 patients whose test results for IgA EMA were negative were not consistent with CD. Of the 150 patients without CD, 72 had a functional disorder, 70 had an organic disease (involving the small bowel in 11 cases), and 8 had a non–GI-related disorder (Table 1). Regarding US signs, mean ± SD values for gallbladder volume, transverse diameter of small bowel loops, bowel wall thickening, and diameter of mesenteric lymph nodes in patients with and without CD were 25 ± 5.3 mL vs 11 ± 4 mL (P<.001); 2.8 ± 1.0 cm vs 1.1 ± 0.6 cm (P<.001); 3.5 ± 1.1 mm vs 1.6 ± 0.4 mm (P<.001), and 4.6 ± 2.9 mm vs 2.3 ± 1.4 mm (P<.001), respectively. In patients with CD, even in the case of small bowel wall thickening, the layer stratification was normal and the mesenteric lymph nodes, even if enlarged, maintained both a normal echotexture and a normal echogenic hilum. The main US characteristics observed in patients with CD are exemplified in Figure 1 for a single case. No differences were observed regarding the US signs between patients with chronic diarrhea (n = 7) and those with iron deficiency anemia (n = 4) or dyspepsia (n = 1). The percentage agreement beyond chance between the US signs and duodenal histological findings in patients with CD is shown in Table 2. The agreement was "moderate" for increased gallbladder volume, thickened small bowel wall, increased peristalsis, free abdominal fluid, enlarged mesenteric lymph nodes, and the concomitant presence of all 6 US signs (κ = 0.62, 0.45, 0.43, 0.43, 0.46, and 0.46, respectively); and "fair" for dilated small bowel loops and increased intraluminal content, and the presence of at least 1 sign (κ = 0.31 for both). The positive likelihood ratio values of increased gallbladder volume, free abdominal fluid, and enlarged mesenteric lymph nodes were greater than 10 (17.0, 12.5, and 15.6, respectively), thus allowing a confirmatory strategy. The negative likelihood ratio values of dilated small bowel loops and increased peristalsis were 0.1, thus supporting a screening strategy (Table 2). Figure 2 shows the relationship between the sensitivity and (1 − specificity) of each of the US parameters—for at least 1 of these parameters and for the combination of all 6. The presence of at least 1 parameter was the most sensitive and the presence of all 6 parameters the most specific. Eleven (92%) of the 12 patients with CD and 35 (23%) of the 150 patients without CD had at least 1 positive US sign (χ2 = 25.52; P = .001); 4 patients with CD (33%) and 1 patient without CD (0.6%) showed the concomitant presence of all 6 (χ2 = 39.64, P = .001).