P0385 VILLUS ATROPHY IN PEDIATRIC CELIAC DISEASE MAY BE CONFINED TO THE PROXIMAL PART OF THE DUODENUM

Abstract

Introduction: The diagnosis of coeliac disease (CD) is based on the demonstration of abnormal small bowel mucosa with villus atrophy and/or intraepithelial lymphocytosis. In untreated CD proximal small bowel mucosa is considered to be uniformly abnormal. Biopsies from distal duodenum or proximal jejunum are considered as representative small bowel tissue for histopathological examination. In our department all small bowel biopsies sampling are performed endoscopically. We have noticed that in some children with a clinical history and serological tests suggestive of CD villus atrophy was found only in the bulbus duodeni. The aim of this study was to establish the frequency of villus atrophy confined to the bulbus duodeni in children for CD and evaluate if the transitional zone between normal and pathologic mucosa could be situated more proximal than previously stated Methods: Retrospective survey of medical records and biopsy reports. All children who underwent upper endoscopy (UEGD) with biopsies from both proximal and distal duodeni in the years 2000–2002 for investigation of CD, inflammatory bowel disease, gastroesophageal reflux disease and abdominal pain were included in the study. Biopsies from 315 UEGD examinations were included, 109 with CD and 206 controls Results: 104 children with CD had mucosal changes compatible with CD in both the distal part of the duodenum and the bulbus duodeni. Five patients, four girls and one boy, age 3–15 years, had mucosal changes compatible with CD in the bulbus duodeni but a normal mucosa in the distal duodenum. All five had a clinical picture and serological tests suggestive of CD. In the 206 controls none had similar mucosal changes in the proximal duodenum Conclusion: Five out of 109 (4,5%) patients with CD had mucosal changes confined to the bulbus duodeni. We speculate that the transitional zone between villus atrophy and normal small bowel mucosa in CD may be situated more proximal than previously thought and that some patients with CD may go undiagnosed unless biopsies are taken from the proximal part of the duodenum.