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Predictors of duodenal bulb biopsy performance in the evaluation of coeliac disease in children.

Abstract

AIMS
Studies on the role of duodenal bulb biopsy (DBB) in coeliac disease (CD) evaluation have increased in recent years; growing evidence suggests that the disease can present solely in the duodenal bulb. Moreover, recent CD guidelines recommend obtaining a DBB. The study aim was to examine DBB performance in children undergoing CD evaluation and to identify independent predictors of DBB performance.
METHODS
The authors performed a structured chart review of children aged <18 years who underwent CD evaluation between 2000 and 2010 at a large teaching hospital. The authors collected data including demographics, serology, endoscopy and histopathological findings. Predictors of DBB performance (obtained vs not obtained) were determined using multivariable logistic regression.
RESULTS
Among 616 children who underwent endoscopy, DBB was performed in 103 children (17%, 95% CI 14% to 20%) with an increasing trend in the more recent years (2008-2010, 25%; 2004-2007, 16%; and 2000-2003, 5%, p<0.001). Three independent predictors of DBB performance were older age at endoscopy (OR 1.05 per year of age), gross gastric antral abnormalities (OR 2.81) and gross duodenal abnormalities (OR 5.55). Regarding the DBB histological findings, patchiness of CD was found in 15%. Positive Marsh III biopsy presented solely on the DBB in 6/103 (6%, 95% CI 2% to 12%) children.
CONCLUSIONS
The authors found a significant increase in DBB performance over time, but the overall performance remains suboptimal. Improving education on obtaining a DBB for CD evaluation is crucial, especially among those children in whom DBB is more likely to be omitted.

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  • Publisher Full Text

    • Authors

    Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo CA

    Institution

    Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts, USA.

    Source

    Journal of clinical pathology 65:9 2012 Sep pg 791-4

    MeSH

    Adolescent
    Age Factors
    Biopsy
    Boston
    Celiac Disease
    Chi-Square Distribution
    Child
    Child, Preschool
    Duodenum
    Endoscopy, Gastrointestinal
    Female
    Humans
    Infant
    Infant, Newborn
    Intestinal Mucosa
    Logistic Models
    Male
    Multivariate Analysis
    Odds Ratio
    Predictive Value of Tests
    Prognosis
    Time Factors

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22718844