Patchy villous atrophy of the duodenum in childhood celiac disease.
OBJECTIVE
Patchy villous atrophy of the duodenal mucosa has been described in adults with untreated celiac disease (CD) but not in children. The authors evaluated the presence and the distribution of villous atrophy in children with celiac disease to see whether this histologic pattern exists in children.


METHODS
We studied 95 children at diagnosis (Group 1) and seven during gluten challenge (Group 2). We measured anti-endomysium antibodies (EMA) by immunofluorescence on monkey esophagus, antihuman-tissue transglutaminase autoantibodies (anti-tTG Abs) by radioimmunoprecipitation, and HLA-DQ2/DQ8 heterodimers by polymerase chain reaction using specific primers. During upper intestinal endoscopy, at least five duodenal biopsy samples were obtained, one from the duodenal bulb and four from the distal duodenum.


RESULTS
Thirteen of 95 (13.7%) patients in Group 1 and in 3 of 7 (42.9%) in Group 2 had patchy villous atrophy of the duodenum. In all 16 patients, villous atrophy of the bulb was present. In four children from Group 1, villous atrophy was observed only in the bulb samples. EMA, anti-tTG Abs, and HLA-DQ2/DQ8 heterodimers were present in all patients. Fourteen of 16 had symptomatic CD, and two were silent, detected during screening in subjects at risk for CD.


CONCLUSIONS
This is the first study demonstrating that children with CD may have patchy villous atrophy of the duodenum. The bulb mucosa may be the only duodenal area involved, both at diagnosis and after gluten challenge. Therefore, multiple endoscopic biopsies should always be performed, not only in the distal duodenum, but also in the bulb.
Bonamico
Margherita
M
Department of Pediatrics, University of Rome La Sapienza, Rome, Italy. margherita.bonamico@uniroma1.it
Mariani
Paolo
P
Thanasi
Enina
E
Ferri
Mirella
M
Nenna
Raffaella
R
Tiberti
Claudio
C
Mora
Barbara
B
Mazzilli
Maria Cristina
MC
Magliocca
Fabio Massimo
FM
D000293:Adolescent; D000328:Adult; D001284:Atrophy / Q000097:blood / Q000276:immunology / Q000473:pathology; D001323:Autoantibodies / Q000276:immunology*; D002446:Celiac Disease / Q000097:blood / Q000276:immunology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000276:immunology / Q000473:pathology*; D016145:Endoscopy, Digestive System; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005983:Glutens / Q000008:administration & dosage; D006683:HLA-DQ Antigens / Q000097:blood; D006650:Histocompatibility Testing; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007223:Infant; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology*; D008297:Male
D001323:Autoantibodies; D006683:HLA-DQ Antigens; D007070:Immunoglobulin A; D005983:Glutens