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Immunohistologic analysis of the duodenal bulb: a new method for celiac disease diagnosis in children.
Gastrointest Endosc 2018; 88(3):521-526GE

Abstract

BACKGROUND AND AIMS

Anti-tissue transglutaminase antibodies (anti-tTG) have simplified celiac disease (CD) diagnosis. However, in atypical forms of CD, intestinal biopsy sampling is still required. This prospective study investigates whether histologic analysis of the duodenal bulb combined with intestinal IgA anti-tTG deposit immunoassay makes CD diagnosis possible in at-risk children with low concentrations of serum anti-tTG.

METHODS

Histologic and intestinal IgA anti-tTG deposit immunoassays were used.

RESULTS

Two hundred forty-five symptomatic children positive for serum anti-tTG (>7 U/mL) were enrolled and divided into 3 groups: extensive duodenal atrophy (n = 209), with IgA anti-tTG deposits throughout the duodenum and high serum anti-tTG concentrations (157 ± 178 U/mL); bulb duodenal atrophy (n = 22), with widespread IgA anti-tTG deposits in 9 and in the bulb alone in 13 and low serum anti-tTG concentrations (13.9 ± 8.7 U/mL); and normal duodenum (n = 14), with widespread IgA anti-tTG deposits in 8 and in the bulb alone in 6 and low serum anti-tTG concentrations (10.6 ± 6.2 U/mL). All patients in the first 2 groups were diagnosed with CD and 8 from the third group. All improved after 1 year of gluten-free diet. Bulb duodenal analysis led to a 12% (30/245) increase in CD diagnosis. No CD-related lesions were observed in the 30 control subjects.

CONCLUSIONS

In children at risk for CD, bulb duodenum biopsy sampling is essential to identify villous atrophy and detect IgA anti-tTG deposits even in absence of intestinal lesions. These mucosal autoantibodies could well represent a new standard for diagnosing CD.

Authors+Show Affiliations

Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy.Second Pathology Department, Spedali Civili, Brescia, Italy.Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy.Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy.Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy.Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy.Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy.Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy.University of Trieste, Trieste, Italy.Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy; University of Trieste, Trieste, Italy.Institute for Maternal and Child Health-IRCCS "Burlo Garofolo" Trieste, Trieste, Italy; University of Trieste, Trieste, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29807020

Citation

De Leo, Luigina, et al. "Immunohistologic Analysis of the Duodenal Bulb: a New Method for Celiac Disease Diagnosis in Children." Gastrointestinal Endoscopy, vol. 88, no. 3, 2018, pp. 521-526.
De Leo L, Villanacci V, Ziberna F, et al. Immunohistologic analysis of the duodenal bulb: a new method for celiac disease diagnosis in children. Gastrointest Endosc. 2018;88(3):521-526.
De Leo, L., Villanacci, V., Ziberna, F., Vatta, S., Martelossi, S., Di Leo, G., ... Not, T. (2018). Immunohistologic analysis of the duodenal bulb: a new method for celiac disease diagnosis in children. Gastrointestinal Endoscopy, 88(3), pp. 521-526. doi:10.1016/j.gie.2018.05.014.
De Leo L, et al. Immunohistologic Analysis of the Duodenal Bulb: a New Method for Celiac Disease Diagnosis in Children. Gastrointest Endosc. 2018;88(3):521-526. PubMed PMID: 29807020.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immunohistologic analysis of the duodenal bulb: a new method for celiac disease diagnosis in children. AU - De Leo,Luigina, AU - Villanacci,Vincenzo, AU - Ziberna,Fabiana, AU - Vatta,Serena, AU - Martelossi,Stefano, AU - Di Leo,Grazia, AU - Zanchi,Chiara, AU - Bramuzzo,Matteo, AU - Giudici,Fabiola, AU - Ventura,Alessandro, AU - Not,Tarcisio, Y1 - 2018/05/26/ PY - 2018/01/23/received PY - 2018/05/19/accepted PY - 2018/5/29/pubmed PY - 2018/12/15/medline PY - 2018/5/29/entrez SP - 521 EP - 526 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 88 IS - 3 N2 - BACKGROUND AND AIMS: Anti-tissue transglutaminase antibodies (anti-tTG) have simplified celiac disease (CD) diagnosis. However, in atypical forms of CD, intestinal biopsy sampling is still required. This prospective study investigates whether histologic analysis of the duodenal bulb combined with intestinal IgA anti-tTG deposit immunoassay makes CD diagnosis possible in at-risk children with low concentrations of serum anti-tTG. METHODS: Histologic and intestinal IgA anti-tTG deposit immunoassays were used. RESULTS: Two hundred forty-five symptomatic children positive for serum anti-tTG (>7 U/mL) were enrolled and divided into 3 groups: extensive duodenal atrophy (n = 209), with IgA anti-tTG deposits throughout the duodenum and high serum anti-tTG concentrations (157 ± 178 U/mL); bulb duodenal atrophy (n = 22), with widespread IgA anti-tTG deposits in 9 and in the bulb alone in 13 and low serum anti-tTG concentrations (13.9 ± 8.7 U/mL); and normal duodenum (n = 14), with widespread IgA anti-tTG deposits in 8 and in the bulb alone in 6 and low serum anti-tTG concentrations (10.6 ± 6.2 U/mL). All patients in the first 2 groups were diagnosed with CD and 8 from the third group. All improved after 1 year of gluten-free diet. Bulb duodenal analysis led to a 12% (30/245) increase in CD diagnosis. No CD-related lesions were observed in the 30 control subjects. CONCLUSIONS: In children at risk for CD, bulb duodenum biopsy sampling is essential to identify villous atrophy and detect IgA anti-tTG deposits even in absence of intestinal lesions. These mucosal autoantibodies could well represent a new standard for diagnosing CD. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/29807020/Immunohistologic_analysis_of_the_duodenal_bulb:_a_new_method_for_celiac_disease_diagnosis_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(18)32708-1 DB - PRIME DP - Unbound Medicine ER -