title: Role of routine small intestinal biopsy in adult patient with irritable bowel syndrome-like symptoms.
abstract: OBJECTIVE
  The clinical evaluation of patients with chronic diarrhea and/or abdominal pain requires a complex work-up. The aim of the study was to evaluate whether routine duodenal biopsy sampling of macroscopically normal mucosa of patients with irritable bowel syndrome-like symptoms undergoing upper endoscopy assists in diagnosis and management.
  
  
  METHODS
  Consecutive adults scheduled for upper endoscopy for evaluation of uninvestigated dyspepsia and abdominal pain and/or chronic diarrhea based upon the history, were enrolled. Gastric biopsies and 3 duodenal biopsies were taken for histological evaluation.
  
  
  RESULTS
  A total of 786 sets of biopsies from 262 consecutive patients (200 females and 62 males, mean age 46 years; range: 15-82), were analyzed. Microscopic damage was observed in 212 of 262 patients (81%) with normal mucosa. Mild to moderate and severe duodenitis or villi atrophy was histologically confirmed in 65%, 26% and 8% of 212 patients respectively. The negative predictive value of a normal appearing duodenal mucosa was 19%. Additional tests confirmed celiac disease in 12 patients. Lactose malabsorption was present in 42%, bacterial overgrowth in 14%, and H. pylori infection in 28%. Colonoscopy performed in 92 patients revealed non specific colitis (25%), microscopic colitis (28%), Crohn's disease (1%), and diverticulosis (15%).
  
  
  CONCLUSIONS
  Duodenal biopsies revealed abnormalities in the majority of adults with chronic diarrhea and/or abdominal pain despite macroscopically normal gross findings. These results suggest that duodenal biopsies could be helpful in patients with chronic diarrhea and/or abdominal pain for the following work up.
authors.affiliation: Departiment of Clinical Medicine, University of Sassari, Sassari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pironti
authors.forename: V
authors.initials: V
authors.lastname: Tadeu
authors.forename: A
authors.initials: A
authors.lastname: Pedroni
authors.forename: A
authors.initials: A
authors.lastname: Porcu
authors.forename: A
authors.initials: A
authors.lastname: Manca
authors.forename: G
authors.initials: G
authors.lastname: Massarelli
authors.forename: G
authors.initials: G
authors.lastname: Realdi
authors.forename: M P
authors.initials: MP
authors.lastname: Dore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D002446:Celiac Disease / Q000175:diagnosis; D003113:Colonoscopy; D004382:Duodenitis / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D043183:Irritable Bowel Syndrome / Q000473:pathology*; D007787:Lactose Intolerance / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000473:pathology*; D055815:Young Adult