Diagnostic value of duodenal bulb biopsy in patients with celiac disease

Abstract

Aims Multiple endoscopic biopsies from the descending duodenum are usually recognised as the standardised method for the evaluation of mucosal changes in celiac disease. Generally, the duodenal bulb is not considered a useful site for biopsies, due to some difficulties in histological evaluation. We wanted to verify if duodenal bulb histology established a correct diagnosis of celiac disease. Methods Fifty-two consecutive children with suspicion of celiac disease and positive anti-tissue transglutaminase (tTG) antibodies were enrolled in a prospective fashion. During upper gastrointestinal (GI) endoscopy, two of four biopsies each were taken from descending duodenum distal to the papilla of Vater (D 2 ) and duodenal bulb (B). The histological lesions were classified according to the modified Oberhuber classification by a single pathologist who was blinded to the site of biopsy. Results A total of 52 children had a final diagnosis of CD. The main presenting symptoms were diarrhea 43/52 (82.7%), anaemia 40/52 (76.9%) and failure to thrive 32/52 (61.5%). All had type 3 lesion– (a) mild, (b) moderate, or (c) severe– in at least one site. There were 45/52 (86.5%) CD patients with lesions of identical type (2 or 3) in both biopsy sites. The number of intraepithelial lymphocytes was not significantly different in the descending part of the duodenum as compared to the duodenal bulb. Conclusions The biopsies from the duodenal bulb and second part of the duodenum in celiac disease can be equally representative of the underlying disease. The diagnosis of celiac disease can reliably be made even if biopsies are taken from the duodenal bulb rather than distal duodenum or jejunum.