The Role of Duodenal Bulb Biopsy in the Diagnosis of Celiac Disease in Children

Abstract

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.

Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?

“…However, recent studies demonstrated that macroscopic changes in celiac disease do occur in the duodenal bulb and in some patients (1.8%-14%) may be the only site of villous atrophy. [13][14][15][16][17][18][19][20] These findings support our group's previous work in which patchy villous atrophy was identified within the duodenum in patients with glutensensitive enteropathy. 20 The rationale in taking duodenal bulb biopsy specimens could be substantiated by a conventional understanding that villous atrophy is most severe proximally where the gluten load is greatest.…”

Predictors of duodenal bulb biopsy performance in the evaluation of coeliac disease in children

“…Concurrent with the recent surge of studies and clinical guidelines on DBB and CD,4 9 13 a DBB was more likely to be performed during 2008–2010 as compared with 2004–2007 and 2000–2003 (25% vs 16% vs 5%, respectively; χ 2 =21.3, p<0.001). Table 2 demonstrates unadjusted predictors of DBB performance in children, including older age at endoscopy, gross gastric antral abnormalities and gross duodenal abnormalities (all p<0.05).…”

“…Recent evidence demonstrates that patchiness and focality of CD can be observed in both children and adults 4–9. Furthermore, research investigations on the role of duodenal bulb biopsy (DBB) in CD evaluation have been greatly increased over the past 5 years 4 7 10 11. Several studies have shown that most CD patients had positive biopsy in the duodenal bulb4 9 11 and that CD can present solely in the duodenal bulb (with a normal villous morphology in the more distal duodenum) in 2%–10% of children 4 7 10–12.…”

“…Furthermore, research investigations on the role of duodenal bulb biopsy (DBB) in CD evaluation have been greatly increased over the past 5 years 4 7 10 11. Several studies have shown that most CD patients had positive biopsy in the duodenal bulb4 9 11 and that CD can present solely in the duodenal bulb (with a normal villous morphology in the more distal duodenum) in 2%–10% of children 4 7 10–12. Moreover, the current paediatric CD guideline13 suggests performing a DBB while performing upper gastrointestinal (GI) endoscopy to increase the diagnostic yield for CD evaluation and to avoid missed or delayed diagnosis which can lead to potentially detrimental health consequences 14 15…”

Usefulness of tissue transglutaminase type 2 antibodies in early pregnancy

“…Mothers positive for both TG2 IgA and EMA underwent esophagogastroduodenoscopy and biopsies were taken from the second part of duodenum. (33) Histological lesions were classified according to modified Marsh criteria. (34) …”