Bulb biopsies for the diagnosis of celiac disease in pediatric patients

BACKGROUND:

Celiac disease (CD) is a gluten-dependent enteropathy. The current standard for diagnosing CD involves obtaining 4 biopsy samples from the descending duodenum. It has been suggested that duodenal bulb biopsies may also be useful.

OBJECTIVE:

To assess the utility of bulbar biopsies for the diagnosis of CD in pediatric patients.

DESIGN:

Prospective study.

SETTING:

Single center.

PATIENTS:

Forty-seven consecutively enrolled pediatric patients with celiac serologies and a clinical suspicion of CD.

INTERVENTIONS:

All patients underwent EGD, and 4 biopsy samples were obtained from the duodenal bulb and 4 from the descending duodenum of each child.

MAIN OUTCOME MEASUREMENTS:

The pathologist blindly reported the Marsh histological grade for the diagnosis of CD of the bulb and descending duodenum.

RESULTS:

The diagnosis of CD was histologically confirmed in 89.4% (42/47) of the cases of biopsy samples obtained from the descending duodenum and in all 47 obtained from the bulb. In 35 patients (74.5%), histology was the same in the bulb and duodenum; in 11 (23.4%) cases, the grade of atrophy was higher in the bulb than in the descending duodenum, and 5 (10.6%) had bulb histology positive for CD but negative duodenal findings. One child (2.1%) had a higher histological grade in the duodenum than in the bulb. The diagnostic gain with bulbar biopsies was 10.6%.

LIMITATIONS:

Small sample and absence of a comparison group (asymptomatic children with normal CD antibodies).

CONCLUSIONS:

We suggest examining 4 biopsy samples from the duodenal bulb and 4 from the descending duodenum to improve diagnostic accuracy of CD.