title: The role of duodenal bulb biopsy in the diagnosis of celiac disease in children.
abstract: OBJECTIVE
  It is suggested that for celiac disease (CD) diagnosis, biopsies should also be taken from the duodenal bulb. Whether bulb biopsies suggestive of CD can be found on upper gastrointestinal endoscopy (EGD) done for reasons other than CD diagnosis is not clear. The aim of our study was to evaluate the contribution of routine bulb biopsies to the diagnosis of CD, when taken regardless of prior suspicion of CD.
  
  
  METHODS
  The study included 96 children who underwent EGD for suspected CD and a control group of 69 children who underwent EGD for reasons other than CD. The mucosal changes were evaluated using the Marsh-Oberhuber classification.
  
  
  RESULTS
  Among the 87 children diagnosed with CD, we identified 6 patients (7%) with typical histologic findings only in the bulb (Marsh 3), but also 1 patient (1.1%) with findings only in the distal duodenum (Marsh 2). In 20 patients (23%) the histological changes were more severe in the bulb. One patient had more prominent findings in the second part of the duodenum. None of the control patients had histological changes compatible with CD in the bulb or the second part of the duodenum.
  
  
  CONCLUSIONS
  Our findings suggest that when CD is suspected, biopsies should be taken from both locations (bulb and second part) as mucosal changes may emerge only at one site. Nevertheless, the presence of characteristic histology on duodenal bulb biopsies might be sufficient for the diagnosis of CD.
authors.affiliation: Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider's Children Medical Center, Petach Tikvah, Israel. rachelile@yahoo.com
authors.forename: Rachel
authors.initials: R
authors.lastname: Levinson-Castiel
authors.forename: Corina
authors.initials: C
authors.lastname: Hartman
authors.forename: Sara
authors.initials: S
authors.lastname: Morgenstern
authors.forename: Yaron
authors.initials: Y
authors.lastname: Avitzur
authors.forename: Akiva
authors.initials: A
authors.lastname: Hirsch
authors.forename: Yoram
authors.initials: Y
authors.lastname: Rosenbach
authors.forename: Rivka
authors.initials: R
authors.lastname: Shapiro
authors.forename: Noam
authors.initials: N
authors.lastname: Zevit
authors.forename: Hava
authors.initials: H
authors.lastname: Fleischaker
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000473:pathology*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012720:Severity of Illness Index