Archaeology dig into the duodenal biopsy

Abstract

Who does not know Dr. Henry Jones Jr., alias Indiana Jones, amous Professor of Archaeology travelling all over the world to iscover the truth behind mysteries like the Lost Ark, the Sankara tones or even the Holy Grail? In the field of Archaeology onemust arefully prepare the expedition before embarking into an advenure to exotic and often dangerous places asking himself or herself hequestion “whatobject amI looking for?”andespecially “whyam looking for that particular object?”. The same questions may arise hen thinking about the indications and consequences of duodeal biopsies. In this issue of Digestive and Liver Disease, SusanneW. armack andRobertM. Genta aimed to answer these twoquestions y analysing 103,385 patients who underwent an oesophagogasroduodenosocopy (EGD) during a 12-month period [1]. Indeed, heir findings reveal some highly interesting aspects that help to etter understand the meaning of a duodenal biopsy. First, the ost commonly stated indications for an EGD in patients with nd without duodenal biopsy were dyspepsia, anaemia, suspected prue, malabsorption, diarrhoea, weight loss and gastroesophaal reflux disease (GERD). Second, the duodenal biopsy patients 28,210) were younger when compared to the “non-duodenal iopsy” patients (52 versus 58 years, p<0.001) and more likely elonged to the female gender (OR 1.46; p<0.001). Third, in 80% of duodenal biopsy” patients a normal duodenum could be detected xcept in those with suspicion of sprue who showed normal findngs in 64%. Fourth, women were more likely to have normal uodenal mucosa (82.3% versus 74.2%; OR 1.62 95% CI 1.53–1.72; <0.0001) and duodenal lymphocytosis (5.2% versus 1.9%; OR 2.82 5% CI 1.94–4.11; p<0.0001) whereas men seemed to show a uodenitis more frequently as compared to women (13.9% verus 6.5%; OR 0.43 95% CI 0.40–0.47). Based on these main results he authors conclude that the clinical suspicion of sprue is freuently associated with histopathological abnormalities and that omen are more frequently biopsied despite having less duodenal athology. Therefore, the present study clearly highlights the importance f multidisciplinary management especially in potential celiac dis-