Bulb biopsies for the diagnosis of celiac disease in pediatric patients.
BACKGROUND
Celiac disease (CD) is a gluten-dependent enteropathy. The current standard for diagnosing CD involves obtaining 4 biopsy samples from the descending duodenum. It has been suggested that duodenal bulb biopsies may also be useful.


OBJECTIVE
To assess the utility of bulbar biopsies for the diagnosis of CD in pediatric patients.


METHODS
Prospective study.


METHODS
Single center.


METHODS
Forty-seven consecutively enrolled pediatric patients with celiac serologies and a clinical suspicion of CD.


METHODS
All patients underwent EGD, and 4 biopsy samples were obtained from the duodenal bulb and 4 from the descending duodenum of each child.


METHODS
The pathologist blindly reported the Marsh histological grade for the diagnosis of CD of the bulb and descending duodenum.


RESULTS
The diagnosis of CD was histologically confirmed in 89.4% (42/47) of the cases of biopsy samples obtained from the descending duodenum and in all 47 obtained from the bulb. In 35 patients (74.5%), histology was the same in the bulb and duodenum; in 11 (23.4%) cases, the grade of atrophy was higher in the bulb than in the descending duodenum, and 5 (10.6%) had bulb histology positive for CD but negative duodenal findings. One child (2.1%) had a higher histological grade in the duodenum than in the bulb. The diagnostic gain with bulbar biopsies was 10.6%.


CONCLUSIONS
Small sample and absence of a comparison group (asymptomatic children with normal CD antibodies).


CONCLUSIONS
We suggest examining 4 biopsy samples from the duodenal bulb and 4 from the descending duodenum to improve diagnostic accuracy of CD.
Mangiavillano
Benedetto
B
Gastrointestinal Endoscopy, Azienda Ospedaliera San Paolo University Hospital, University of Milan, Italy. b_mangiavillano@hotmail.com
Masci
Enzo
E
Parma
Barbara
B
Barera
Graziano
G
Viaggi
Paolo
P
Albarello
Luca
L
Tronconi
Giulia Maria
GM
Mariani
Alberto
A
Testoni
Sabrina
S
Santoro
Tara
T
Testoni
Pier Alberto
PA
D001284:Atrophy; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000473:pathology*; D002648:Child; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies