Efficacy of duodenal bulb biopsy for diagnosis of celiac disease: a systematic review and meta-analysis

Abstract

Background and study aims Although duodenal biopsy is considered the “gold standard” for diagnosis of celiac disease, the optimal location of biopsy within the small bowel for diagnosis remains unclear. The primary aim of this study was to perform a structured systematic review and meta-analysis to evaluate the diagnostic utility of endoscopic duodenal bulb biopsy for celiac disease. Patients and methods Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed from 2000 through December 2017. Review of titles/abstracts, full review of potentially relevant studies, and data abstraction was performed. Measured outcomes of adult and pediatric patients included location of biopsy, mean number of biopsies performed, and diagnosis of celiac disease as defined by the modified Marsh-Oberhuber classification. Results A total of 17 studies (n = 4050) were included. Seven studies evaluated adults and 11 studies assessed pediatric populations. Mean age of adults and pediatric patients was 46.70 ± 2.69 and 6.33 ± 1.26 years, respectively. Overall, sampling from the duodenal bulb demonstrated a 5 % (95 % CI 3 – 9; P < 0.001) increase in the diagnostic yield of celiac disease. When stratified by pediatric and adult populations, duodenal bulb biopsy demonstrated a 4 % (95 % CI: 1 to 9; P < 0.001) and 8 % (95 % CI: 6 to 10; P < 0.001) increase in the diagnostic yield of celiac disease. Non-celiac histologic diagnoses including Brunner gland hyperplasia and peptic duodenitis were reported more commonly in the duodenal bulb as compared to the distal duodenum with an increase in diagnostic yield of 4 % (95 % CI 3 – 5; P < 0.001) and 1 % (95 % CI 1 – 2; P < 0.001), respectively. Conclusions Based upon our results, biopsy and histologic examination of duodenal bulb during routine upper endoscopy increases the diagnostic yield of celiac disease.

Correlation of TTG IgA level with small intestinal histopathological changes for celiac disease among adult Saudi patients

“…Female preponderance in our study (73%) is comparable with this as well as other international studies. [19] Extensive literature review and meta-analysis performed by McCarty et al [20] revealed that duodenal bulb biopsy increases the diagnostic yield by 5% and 4% in adults and children, respectively. In our study, although there was no strict criteria for duodenal bulb biopsy, but overall 9.3% (n = 13) of patients with CD were diagnosed on biopsy alone, with TTG IgA level <20 units.…”

Effects of Helicobacter Pylori Infection on Serology and Intestinal Mucosal Changes in Pediatric Patients With Celiac Disease: A Retrospective Cohort Study

“…Three biopsy samples per patient were taken from the distal duodenum. Duodenal ampulla biopsies were routinely obtained since 2010 because the latest studies have suggested that that region may be the only region affected by CD [8].…”

An updated overview of spectrum of gluten-related disorders: clinical and diagnostic aspects

“…An antibody test followed by a small intestinal biopsy evaluation is the gold standard for the definitive diagnosis of CD [36,39]. Adequate small intestinal sampling is essential in this regard and studies have concluded that at least one biopsy from the duodenal bulb and at least four biopsies from the distal duodenum are needed for an accurate diagnosis [40,41]. Biopsy appearances in keeping with CD include scalloping, villous flattening, and fissuring of mucosal folds.…”

“…Biopsy appearances in keeping with CD include scalloping, villous flattening, and fissuring of mucosal folds. Small intestinal appearances can become more pronounced with disease progression [17,40,41]. According to the Marsh classification, the intestinal biopsy changes are classified on the extent of increased intraepithelial lymphocytes, crypt hyperplasia, and villous atrophy [42].…”