The Role of the Bulb Biopsies in Children with Celiac Disease

Abstract

Background: The gold standard of Celiac Disease (CD) diagnosis is up to know based on characteristically histological features, according to Marsh criteria modified by Oberhuber (M/O). The biopsies are actually performed in descending duodenum, 1 for each quadrant (Seattle's criteria). Only few cases have been reported in literature in which diagnosis was made with the aid of biopsies in the duodenal bulb. Aim: To assess the role of duodenal biopsy in a selected population of paediatric patients undergone esophagogastroduodenoscopy (EGD) for suspected CD, because of gluten-autoantibodies positivity. PATIENTS And Methods: We prospectively enrolled 41 paediatric patients (14 M, 27 F; age: 7.5+/-9.9 ys) with suspicion of CD referred to our Hospital for performing OGD for histological diagnosis, because of the positivity of the anti-endomysium IgA antibodies (EmA), IgA and IgG anti-tissue transglutaminase (tTG-Ab) antibodies. During the EGD we took 4 mucosal biopsies from the duodenal bulb and 4 in the descending duodenum (1/quadrant). The histological specimens were fixed in 10% formalin and stained with hematoxylin and eosin (H&E). The pathologist reported blindly the histological M/O diagnosis of the bulb and of the descending duodenum. Results: Of the 41 paediatric enrolled patients: - 31 subjects (75.7%) had the same histology in bulb and descending duodenum: 5 pts had IIIa M/O (16.1%); 10 pts had IIIb M/O (32.3%); 16 pts had IIIc M/O (51.6%).- 9 subjects (21.9%) had the bulb histological atrophy grade major than the duodenal one, and in five of these (12.2%) the descending duodenal biopsies were negative for CD (0 M/O) (Tab.1).- 1 subjects (2.4%) presented the duodenal histological atrophy grade major than the bulb (bulb = IIIa and descending duodenum = IIIb). Conclusions: This study suggests that performing biopsies only in the descending duodenum to define CD diagnosis could be not enough. If further studies will confirm this preliminary data, we suggest to perform four bulbar biopsies for the histological CD diagnosis instead of the descending duodenal ones.