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Assessment of the diagnostic value of duodenal bulb histology in patients with celiac disease, using multiple biopsy sites.
J Clin Gastroenterol. 2009 Apr; 43(4):307-11.JC

Abstract

BACKGROUND

Multiple endoscopic biopsies from the descending duodenum are usually recognized as the standardized method for the evaluation of mucosal changes in celiac disease (CD). Generally, the duodenal bulb is not considered a useful site for biopsies, owing to some difficulties in histologic evaluation.

GOAL

We wanted to verify if duodenal bulb histology establish a correct diagnosis of CD.

STUDY

Fifty-two consecutive children with suspicion of CD and positive antitissue transglutaminase antibodies were enrolled in a prospective fashion. During upper gastrointestinal endoscopy, 2 to 4 biopsies each were taken from descending duodenum distal to the papilla of Vater (D2) and duodenal bulb (B). The histologic lesions were classified according to the modified Oberhuber classification by single pathologist who was blinded to the site of biopsy.

RESULTS

A total of 52 children had a final diagnosis of CD. The main presenting symptoms were diarrhea 43/52 (82.7%), anemia 40/52 (76.9%), and failure to thrive 32/52 (61.5%). All had type 3 lesion-(a) mild, (b) moderate, or (c) severe-in at least 1 site. There was 45/52 (86.5%) CD patients with lesions of identical type (type 2 or 3) in both biopsy sites. The number of intraepithelial lymphocytes was not significantly different in the descending part of the duodenum as compared with duodenal bulb.

CONCLUSIONS

The biopsies from the duodenal bulb and second part of the duodenum in CD can be equally representative of the underlying disease. The diagnosis of CD can reliably be made even if biopsies are taken from the duodenal bulb rather than distal duodenum or jejunum.

Authors+Show Affiliations

Division of GE Histopathology and Pediatric Gastroenterology, Department of Superspeciality of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Union Territory, India. kaushalkp10@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

18827714

Citation

Prasad, Kaushal Kishor, et al. "Assessment of the Diagnostic Value of Duodenal Bulb Histology in Patients With Celiac Disease, Using Multiple Biopsy Sites." Journal of Clinical Gastroenterology, vol. 43, no. 4, 2009, pp. 307-11.
Prasad KK, Thapa BR, Nain CK, et al. Assessment of the diagnostic value of duodenal bulb histology in patients with celiac disease, using multiple biopsy sites. J Clin Gastroenterol. 2009;43(4):307-11.
Prasad, K. K., Thapa, B. R., Nain, C. K., & Singh, K. (2009). Assessment of the diagnostic value of duodenal bulb histology in patients with celiac disease, using multiple biopsy sites. Journal of Clinical Gastroenterology, 43(4), 307-11. https://doi.org/10.1097/MCG.0b013e31815b9d11
Prasad KK, et al. Assessment of the Diagnostic Value of Duodenal Bulb Histology in Patients With Celiac Disease, Using Multiple Biopsy Sites. J Clin Gastroenterol. 2009;43(4):307-11. PubMed PMID: 18827714.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of the diagnostic value of duodenal bulb histology in patients with celiac disease, using multiple biopsy sites. AU - Prasad,Kaushal Kishor, AU - Thapa,Babu Ram, AU - Nain,Chander Kanwal, AU - Singh,Kartar, PY - 2008/10/2/pubmed PY - 2009/5/19/medline PY - 2008/10/2/entrez SP - 307 EP - 11 JF - Journal of clinical gastroenterology JO - J Clin Gastroenterol VL - 43 IS - 4 N2 - BACKGROUND: Multiple endoscopic biopsies from the descending duodenum are usually recognized as the standardized method for the evaluation of mucosal changes in celiac disease (CD). Generally, the duodenal bulb is not considered a useful site for biopsies, owing to some difficulties in histologic evaluation. GOAL: We wanted to verify if duodenal bulb histology establish a correct diagnosis of CD. STUDY: Fifty-two consecutive children with suspicion of CD and positive antitissue transglutaminase antibodies were enrolled in a prospective fashion. During upper gastrointestinal endoscopy, 2 to 4 biopsies each were taken from descending duodenum distal to the papilla of Vater (D2) and duodenal bulb (B). The histologic lesions were classified according to the modified Oberhuber classification by single pathologist who was blinded to the site of biopsy. RESULTS: A total of 52 children had a final diagnosis of CD. The main presenting symptoms were diarrhea 43/52 (82.7%), anemia 40/52 (76.9%), and failure to thrive 32/52 (61.5%). All had type 3 lesion-(a) mild, (b) moderate, or (c) severe-in at least 1 site. There was 45/52 (86.5%) CD patients with lesions of identical type (type 2 or 3) in both biopsy sites. The number of intraepithelial lymphocytes was not significantly different in the descending part of the duodenum as compared with duodenal bulb. CONCLUSIONS: The biopsies from the duodenal bulb and second part of the duodenum in CD can be equally representative of the underlying disease. The diagnosis of CD can reliably be made even if biopsies are taken from the duodenal bulb rather than distal duodenum or jejunum. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/18827714/Assessment_of_the_diagnostic_value_of_duodenal_bulb_histology_in_patients_with_celiac_disease_using_multiple_biopsy_sites_ L2 - https://doi.org/10.1097/MCG.0b013e31815b9d11 DB - PRIME DP - Unbound Medicine ER -