P0450 IS BULBAR MUCOSA THE FIRST LOCALISATION OF INTESTINAL LESIONS IN COELIAC DISEASE?

Abstract

Introduction: Recently has been reported that the hyperplastic villous atrophy of the small bowel mucosa of coeliac disease (CD), considered to be diffuse in children (1), could be patchily distributed (2). Aim of the study was to investigate the incidence of bulbar lesions in CD children and adolescents at the diagnosis. Methods: We studied 128 patients (47 males, range 12 months-18 years and 10 months, median age 5 years and 5 months) at the CD diagnosis, according to the ESPGHAN criteria. Anti-endomysium antibodies (AEA) have been determined by immunofluorescence method and anti-tissue transglutaminase antibodies (anti-tTGase Ab) using 35S-human recombinant tTG in an immunoprecipitation assay. HLA was typed by polymerase chain reaction using specific primers. The patients have been submitted to upper endoscopy and at least five samples have been collected: one in the bulbous and four in the second and the third portion of the duodenum. Results: In 8/128 patients (6.3%, two males, range 20 months-11 years and 5 months, median age 5 years and 5 months) a total-subtotal villous atrophy was detected only in the bulbar sample. All these patients were AEA and anti-tTGase Ab positive; 6 patients HLA typed, resulted DQ2 or DQ8 positive. Clinical presentation of CD was typical in 5 children, atypical in 2 and silent in one child. In addition, in 19 patients a patchy distribution of villous atrophy has been detected in the duodenal samples. In these children and in those with a diffuse distribution of villous atrophy, bulbar lesions were always present. Conclusion: The results of our study show that in CD patients the bulbar mucosa is always involved by histological lesions. Particularly, in 6.3% of our cases it was the only area damaged. Our observation demonstrates that bulb is the most gluten sensible area involved in CD. Therefore, in order to obtain a sure diagnosis, biopsies on bulbar area should be always performed.