title: Sampling of proximal and distal duodenal biopsies in the diagnosis and monitoring of celiac disease.
abstract: BACKGROUND
  Since celiac disease-associated mucosal lesions are patchy, the diagnosis of the disease requires histological evaluation of multiple duodenal biopsies.
  
  
  OBJECTIVE
  To examine whether adequate biopsy sampling in either the bulb or distal duodenum is sufficient to diagnose celiac disease.
  
  
  METHODS
  Twenty-five patients with positive celiac disease-specific serology and 17 patients with negative serology, who were on a gluten-containing diet, and 13 celiac disease patients on a gluten-free diet were consecutively and prospectively enrolled. Mucosal damage, anti-transglutaminase-2 IgA deposits, interferon-γ, interleukin-17A and interleukin-15 transcripts were evaluated in bulb and distal duodenal biopsies.
  
  
  RESULTS
  All patients with positive celiac disease-specific serology exhibited villous atrophy in both duodenal sites. In this group, mucosal anti-transglutaminase-2 IgA deposits were found in 24/25 (96%) bulb samples and 22/25 (88%) distal duodenal samples. No villous atrophy was documented in patients with negative serology. Interferon-γ and interleukin-17A were over-expressed in both duodenal sites of patients with villous atrophy, unlike patients with normal duodenal morphology (p<0.001). Among treated celiac disease patients, 2 (15.4%) had villous atrophy exclusively in the bulb and 6 (46.2%) had minimal histological abnormalities at both sites.
  
  
  CONCLUSIONS
  Sampling in the bulb and distal duodenum could be sufficient to diagnose/exclude celiac disease.
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Caruso
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Marafini
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Del Vecchio Blanco
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Fina
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Omero Alessandro
authors.initials: OA
authors.lastname: Paoluzi
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Colantoni
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Sedda
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pallone
authors.affiliation: Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy. Electronic address: Gi.Monteleone@Med.uniroma2.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Monteleone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy; D001323:Autoantibodies / Q000276:immunology*; D001706:Biopsy / Q000379:methods; D016022:Case-Control Studies; D002446:Celiac Disease / Q000235:genetics / Q000276:immunology / Q000473:pathology*; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology*; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007371:Interferon-gamma / Q000235:genetics / Q000276:immunology; D019409:Interleukin-15 / Q000235:genetics / Q000276:immunology; D020381:Interleukin-17 / Q000235:genetics / Q000276:immunology; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012333:RNA, Messenger / Q000235:genetics*; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; C569274:IL15 protein, human; C508717:IL17A protein, human; D007070:Immunoglobulin A; D019409:Interleukin-15; D020381:Interleukin-17; D012333:RNA, Messenger; D007371:Interferon-gamma; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Anti-transglutaminase-2; Celiac disease; Duodenum; Interferon-gamma