title: Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?
abstract: BACKGROUND
  Recent studies highlight the role of duodenal bulb biopsy in the diagnosis of celiac disease.
  
  
  OBJECTIVE
  To determine whether a targeted duodenal bulb biopsy in addition to distal duodenal biopsies is the optimal strategy to identify villous atrophy.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  Seventy-seven patients undergoing clinically indicated EGD with duodenal biopsies were recruited. Of these, 28 had newly diagnosed celiac disease and 49 were controls.
  
  
  METHODS
  At endoscopy, 8 duodenal biopsy specimens were taken: 4 from the second part of the duodenum and 4 quadrantically from the bulb (at the 3-, 6-, 9-, and 12-o'clock positions).
  
  
  METHODS
  Increasing the diagnostic yield and detection of the most severe villous atrophy in celiac disease with the addition of a targeted duodenal bulb biopsy.
  
  
  RESULTS
  The most severe degree of villous atrophy was detected when distal duodenal biopsy specimens were taken in addition to a duodenal bulb biopsy specimen from either the 9- or 12-o'clock position (96.4% sensitivity; 95% CI, 79.7%-100%). The difference between the 12-o'clock position biopsy and the 3-o'clock position biopsy in detecting the most severe villous atrophy was 92% (24/26) versus 65% (17/26) (P = .02).
  
  
  CONCLUSIONS
  Small sample and study performed in a tertiary referral center.
  
  
  CONCLUSIONS
  This study demonstrates the patchy appearance of villous atrophy that occurs within the duodenum. A targeted duodenal bulb biopsy from either the 9- or 12-o'clock position in addition to distal duodenal biopsies may improve diagnostic yields by detecting the most severe villous atrophy within the duodenum.
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kurien
authors.forename: Kate E
authors.initials: KE
authors.lastname: Evans
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hopper
authors.forename: Melissa F
authors.initials: MF
authors.lastname: Hale
authors.forename: Simon S
authors.initials: SS
authors.lastname: Cross
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D004386:Duodenum / Q000473:pathology*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D007070:Immunoglobulin A; D011503:Transglutaminases