Rospective Study of the Role of Duodenal Bulb Biopsies in the Diagnosis of Celiac Disease

Abstract

Background and Aim: Celiac disease is a systemic immune mediated disorder triggered by dietary gluten in genetically susceptible persons. D1 had been avoided as a possible biopsy site because of concerns over presence of Brunner's glands, gastric metaplasia, peptic duodenitis, and presumed reduced villous height. Prospective data from small studies has suggested that D1 may be the only site of villous atrophy in newly diagnosed celiac disease (ultra-short celiac disease). We wanted to verify this concept that whether the addition of duodenal bulb biopsy increase the diagnostic yield of celiac disease and was there any difference in histological grading between the two sites. Methods: We studied 50 cases of celiac disease those who were symptomatic clinically and positive for celiac serology. Endoscopically four mucosal biopsies each, were taken from the bulb and distal duodenum of each patient and morphology graded as per Modified Marsh grade. Results: In our study of 50 patients, out of 100 biopsies, 60 biopsies (30 patients) showed same Marsh grade in the bulb and descending duodenum and 40 biopsies (20 patients) showed different Marsh grade at both the sites. Patients those have different Marsh grade, descending duodenum showed higher grade than the bulb part in 13 patients while 7 patients showed higher mucosal atrophy in bulb than descending duodenum. Although there was a difference in morphological grade at both the sites, in none of the cases, the bulb biopsy was positive with negative distal duodenal biopsy for celiac disease or vice versa. Conclusion: Biopsy from both sites are mutually exclusive. Taking biopsy samples from both sites maximize the diagnostic yield. Diagnostic yield from bulb biopsy is as good as distal duodenum and could substitute D2 biopsy in paediatric patients. The authors have none to declare.