Kaushal Kishor Prasad1, Babu Ram Thapa, Chander Kanwal Nain, Kartar Singh. 1. Division of GE Histopathology and Pediatric Gastroenterology, Department of Superspeciality of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Union Territory, India. kaushalkp10@hotmail.com
Abstract
BACKGROUND: Multiple endoscopic biopsies from the descending duodenum are usually recognized as the standardized method for the evaluation of mucosal changes in celiac disease (CD). Generally, the duodenal bulb is not considered a useful site for biopsies, owing to some difficulties in histologic evaluation. GOAL: We wanted to verify if duodenal bulb histology establish a correct diagnosis of CD. STUDY: Fifty-two consecutive children with suspicion of CD and positive antitissue transglutaminase antibodies were enrolled in a prospective fashion. During upper gastrointestinal endoscopy, 2 to 4 biopsies each were taken from descending duodenum distal to the papilla of Vater (D2) and duodenal bulb (B). The histologic lesions were classified according to the modified Oberhuber classification by single pathologist who was blinded to the site of biopsy. RESULTS: A total of 52 children had a final diagnosis of CD. The main presenting symptoms were diarrhea 43/52 (82.7%), anemia 40/52 (76.9%), and failure to thrive 32/52 (61.5%). All had type 3 lesion-(a) mild, (b) moderate, or (c) severe-in at least 1 site. There was 45/52 (86.5%) CD patients with lesions of identical type (type 2 or 3) in both biopsy sites. The number of intraepithelial lymphocytes was not significantly different in the descending part of the duodenum as compared with duodenal bulb. CONCLUSIONS: The biopsies from the duodenal bulb and second part of the duodenum in CD can be equally representative of the underlying disease. The diagnosis of CD can reliably be made even if biopsies are taken from the duodenal bulb rather than distal duodenum or jejunum.
BACKGROUND: Multiple endoscopic biopsies from the descending duodenum are usually recognized as the standardized method for the evaluation of mucosal changes in celiac disease (CD). Generally, the duodenal bulb is not considered a useful site for biopsies, owing to some difficulties in histologic evaluation. GOAL: We wanted to verify if duodenal bulb histology establish a correct diagnosis of CD. STUDY: Fifty-two consecutive children with suspicion of CD and positive antitissue transglutaminase antibodies were enrolled in a prospective fashion. During upper gastrointestinal endoscopy, 2 to 4 biopsies each were taken from descending duodenum distal to the papilla of Vater (D2) and duodenal bulb (B). The histologic lesions were classified according to the modified Oberhuber classification by single pathologist who was blinded to the site of biopsy. RESULTS: A total of 52 children had a final diagnosis of CD. The main presenting symptoms were diarrhea 43/52 (82.7%), anemia 40/52 (76.9%), and failure to thrive 32/52 (61.5%). All had type 3 lesion-(a) mild, (b) moderate, or (c) severe-in at least 1 site. There was 45/52 (86.5%) CDpatients with lesions of identical type (type 2 or 3) in both biopsy sites. The number of intraepithelial lymphocytes was not significantly different in the descending part of the duodenum as compared with duodenal bulb. CONCLUSIONS: The biopsies from the duodenal bulb and second part of the duodenum in CD can be equally representative of the underlying disease. The diagnosis of CD can reliably be made even if biopsies are taken from the duodenal bulb rather than distal duodenum or jejunum.
Authors: Brooks D Cash; Joel H Rubenstein; Patrick E Young; Andrew Gentry; Borko Nojkov; Dong Lee; A Hirsohi Andrews; Richard Dobhan; William D Chey Journal: Gastroenterology Date: 2011-07-14 Impact factor: 22.682
Authors: Amani Mubarak; Eric Spierings; Victorien M Wolters; Henny G Otten; Fiebo J W ten Kate; Roderick H J Houwen Journal: World J Gastroenterol Date: 2013-11-07 Impact factor: 5.742