title: Duodenal bulb biopsies in celiac disease: a multicenter study.
abstract: 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.
authors.affiliation: Department of Paediatrics, University La Sapienza of Rome, Rome, Italy. margherita.bonamico@uniroma1.it
authors.forename: Margherita
authors.initials: M
authors.lastname: Bonamico
authors.forename: Enina
authors.initials: E
authors.lastname: Thanasi
authors.forename: Paolo
authors.initials: P
authors.lastname: Mariani
authors.forename: Raffaella
authors.initials: R
authors.lastname: Nenna
authors.forename: Rita Pia Lara
authors.initials: RP
authors.lastname: Luparia
authors.forename: Cristiana
authors.initials: C
authors.lastname: Barbera
authors.forename: Isabella
authors.initials: I
authors.lastname: Morra
authors.forename: Pietro
authors.initials: P
authors.lastname: Lerro
authors.forename: Graziella
authors.initials: G
authors.lastname: Guariso
authors.forename: Costantino
authors.initials: C
authors.lastname: De Giacomo
authors.forename: Serenella
authors.initials: S
authors.lastname: Scotta
authors.forename: Stefano
authors.initials: S
authors.lastname: Pontone
authors.forename: Francesco
authors.initials: F
authors.lastname: Carpino
authors.forename: Fabio Massimo
authors.initials: FM
authors.lastname: Magliocca
mesh_terms: 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
chemical_list: 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