Duodenal bulb biopsies in celiac disease: a multicenter study.
OBJECTIVE
Celiac disease (CD)-related lesions have been reported in duodenal bulb biopsies, sometimes the bulb mucosa being the only one affected. The aim was to verify in a significant series whether histological lesions are always present in the bulb of celiac patients, what is the prevalence of lesions when isolated to the bulb, and if similar lesions are present in nonceliac subjects.


METHODS
We studied 665 children with CD (241 males, range 9 months-15 years, 8 months), at diagnosis on a gluten-containing diet, and 348 age- and sex-matched gastroenterological controls submitted to upper endoscopy for gastroenterological complaints. During endoscopy, multiple biopsies (1 bulb and 4 distal duodenum samples) were taken. Anti-endomysium antibodies were evaluated by immunofluorescence method, anti-human tissue-transglutaminase antibodies by an enzyme-linked immunosorbent assay or radioimmunoassay. Human leukocyte antigen-DRB1, -DQA1, and -DQB1 genes were typed by polymerase chain reaction sequence-specific primers repeat method.


RESULTS
In all of the patients with CD, histological lesions were present in the bulb sample; in 16 of them, the lesions were present only in the bulb. Patchy villous atrophy was found in 20 children. All of the patients with CD were anti-endomysium and/or antitransglutaminase positive. The controls showed neither autoantibody positivity nor mucosal changes compatible with CD.


CONCLUSIONS
This study demonstrated that CD-related histological lesions are always present in the bulb; sometimes this specific site is the only one affected. Therefore, we suggest taking 2 biopsies from the bulb and 2 from the distal duodenum for CD diagnosis.
Bonamico
Margherita
M
Department of Paediatrics, University La Sapienza of Rome, Rome, Italy. margherita.bonamico@uniroma1.it
Thanasi
Enina
E
Mariani
Paolo
P
Nenna
Raffaella
R
Luparia
Rita Pia Lara
RP
Barbera
Cristiana
C
Morra
Isabella
I
Lerro
Pietro
P
Guariso
Graziella
G
De Giacomo
Costantino
C
Scotta
Serenella
S
Pontone
Stefano
S
Carpino
Francesco
F
Magliocca
Fabio Massimo
FM
D000293:Adolescent; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000276:immunology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000166:cytology / Q000473:pathology*; D005260:Female; D006683:HLA-DQ Antigens / Q000235:genetics; D059848:HLA-DQ alpha-Chains; D006684:HLA-DR Antigens / Q000235:genetics; D059811:HLA-DRB1 Chains; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D007413:Intestinal Mucosa / Q000166:cytology / Q000473:pathology*; D008297:Male; D016133:Polymerase Chain Reaction; D012016:Reference Values; D012680:Sensitivity and Specificity
D006683:HLA-DQ Antigens; D059848:HLA-DQ alpha-Chains; C069050:HLA-DQA1 antigen; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; C040626:HLA-Dx antigen; D007070:Immunoglobulin A; D007074:Immunoglobulin G