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Bulb biopsies for the diagnosis of celiac disease in pediatric patients.

Abstract：

BACKGROUND:Celiac disease (CD) is a gluten-dependent enteropathy. The current standard for diagnosing CD involves obtaining 4 biopsy samples from the descending duodenum. It has been suggested that duodenal bulb biopsies may also be useful. OBJECTIVE:To assess the utility of bulbar biopsies for the diagnosis of CD in pediatric patients. DESIGN:Prospective study. SETTING:Single center. PATIENTS:Forty-seven consecutively enrolled pediatric patients with celiac serologies and a clinical suspicion of CD. INTERVENTIONS:All patients underwent EGD, and 4 biopsy samples were obtained from the duodenal bulb and 4 from the descending duodenum of each child. MAIN OUTCOME MEASUREMENTS:The pathologist blindly reported the Marsh histological grade for the diagnosis of CD of the bulb and descending duodenum. RESULTS:The diagnosis of CD was histologically confirmed in 89.4% (42/47) of the cases of biopsy samples obtained from the descending duodenum and in all 47 obtained from the bulb. In 35 patients (74.5%), histology was the same in the bulb and duodenum; in 11 (23.4%) cases, the grade of atrophy was higher in the bulb than in the descending duodenum, and 5 (10.6%) had bulb histology positive for CD but negative duodenal findings. One child (2.1%) had a higher histological grade in the duodenum than in the bulb. The diagnostic gain with bulbar biopsies was 10.6%. LIMITATIONS:Small sample and absence of a comparison group (asymptomatic children with normal CD antibodies). CONCLUSIONS:We suggest examining 4 biopsy samples from the duodenal bulb and 4 from the descending duodenum to improve diagnostic accuracy of CD.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Mangiavillano B,Masci E,Parma B,Barera G,Viaggi P,Albarello L,Tronconi GM,Mariani A,Testoni S,Santoro T,Testoni PA

doi

10.1016/j.gie.2010.05.021

subject

Has Abstract

pub_date

2010-09-01 00:00:00

pages

564-8

issue

3

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(10)01679-2

journal_volume

72

pub_type

杂志文章

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