title: Bulb biopsies for the diagnosis of celiac disease in pediatric patients.
abstract: 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.
authors.affiliation: Gastrointestinal Endoscopy, Azienda Ospedaliera San Paolo University Hospital, University of Milan, Italy. b_mangiavillano@hotmail.com
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mangiavillano
authors.forename: Enzo
authors.initials: E
authors.lastname: Masci
authors.forename: Barbara
authors.initials: B
authors.lastname: Parma
authors.forename: Graziano
authors.initials: G
authors.lastname: Barera
authors.forename: Paolo
authors.initials: P
authors.lastname: Viaggi
authors.forename: Luca
authors.initials: L
authors.lastname: Albarello
authors.forename: Giulia Maria
authors.initials: GM
authors.lastname: Tronconi
authors.forename: Alberto
authors.initials: A
authors.lastname: Mariani
authors.forename: Sabrina
authors.initials: S
authors.lastname: Testoni
authors.forename: Tara
authors.initials: T
authors.lastname: Santoro
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Testoni
mesh_terms: 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