title: Duodenal bulb in celiac adults: the "whether biopsying" dilemma.
abstract: BACKGROUND
  Celiac disease (CD)-related lesions were described in duodenal bulb of celiac patients.
  
  
  OBJECTIVE
  Our aim was to evaluate the morphology of bulb mucosa in adult celiac patients and in controls to evaluate its usefulness for CD diagnosis.
  
  
  METHODS
  We studied 43 celiac patients (10 male, median age: 35.2 y) at diagnosis and 43 gastroenterological controls (10 male, median age: 37.8 y), submitted to upper endoscopy for gastroenterological complaints. Histologic lesions were assayed by an experienced pathologist according to the Marsh modified classification. Antiendomysium antibodies and antitransglutaminase antibodies-tTGAb (ELISA and/or RIA) have been tested. In selected patients, DNA was typed for DRB1, DQA1, and DQB1 genes by sequence-specific primer polymerase chain reaction.
  
  
  RESULTS
  In all celiac patients lesions were present in the bulb mucosa. One female with thyroiditis, who had a CD daughter, showed lesions only in the duodenal bulb. Patchy villous atrophy was found in another patient. All celiacs were antiendomysium and/or tTGAb positive. DQ2 heterodimer was present in 5 CD patients. The gastroenterological controls showed normal mucosa in the duodenum.
  
  
  CONCLUSIONS
  This study demonstrates that CD-related histologic lesions are present in duodenal bulb of adult patients. Moreover, the normal aspect of this mucosa in gastroenterological controls implies the high negative predictive value of this finding. Therefore, we suggest taking at least 1 biopsy on the bulb area and 1 from the distal duodenum for CD diagnosis, in all the patients submitted to upper endoscopy, to avoid missed or delayed diagnosis.
authors.affiliation: Department of Paediatrics, Sapienza University of Rome, Rome, Italy. raffaella.nenna@uniroma1.it
authors.forename: Raffaella
authors.initials: R
authors.lastname: Nenna
authors.forename: Stefano
authors.initials: S
authors.lastname: Pontone
authors.forename: Paolo
authors.initials: P
authors.lastname: Pontone
authors.forename: Laura
authors.initials: L
authors.lastname: Petrarca
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mennini
authors.forename: Monica
authors.initials: M
authors.lastname: Standoli
authors.forename: Gerarda
authors.initials: G
authors.lastname: Mastrogiorgio
authors.forename: Margherita
authors.initials: M
authors.lastname: Bonamico
authors.forename: Fabio Massimo
authors.initials: FM
authors.lastname: Magliocca
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D004386:Duodenum / Q000473:pathology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D059848:HLA-DQ alpha-Chains / Q000235:genetics*; D059866:HLA-DQ beta-Chains / Q000235:genetics*; D059811:HLA-DRB1 Chains / Q000235:genetics; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011863:Radioimmunoassay; D055815:Young Adult
chemical_list: D059848:HLA-DQ alpha-Chains; D059866:HLA-DQ beta-Chains; C069050:HLA-DQA1 antigen; C069051:HLA-DQB1 antigen; D059811:HLA-DRB1 Chains