title: Assessment of the diagnostic value of duodenal bulb histology in patients with celiac disease, using multiple biopsy sites.
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.
  
  
  OBJECTIVE
  We wanted to verify if duodenal bulb histology establish a correct diagnosis of CD.
  
  
  METHODS
  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.affiliation: 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.com
authors.forename: Kaushal Kishor
authors.initials: KK
authors.lastname: Prasad
authors.forename: Babu Ram
authors.initials: BR
authors.lastname: Thapa
authors.forename: Chander Kanwal
authors.initials: CK
authors.lastname: Nain
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000276:immunology; D001706:Biopsy / Q000379:methods*; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000473:pathology*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D000906:Antibodies; D011503:Transglutaminases