Duodenal bulb biopsies in celiac disease: a multicenter study

Area of Science:

• Gastroenterology
• Pediatric Gastroenterology
• Celiac Disease Diagnostics

Background:

• Celiac disease (CD) diagnosis relies on identifying characteristic histological lesions in the small intestine.
• Previous reports suggest CD-related lesions can occur in the duodenal bulb, sometimes exclusively.
• The diagnostic significance of the duodenal bulb in pediatric CD requires further investigation.

Purpose of the Study:

• To determine if histological lesions are consistently present in the duodenal bulb of children with celiac disease.
• To assess the prevalence of celiac disease lesions isolated to the duodenal bulb.
• To investigate the presence of similar lesions in non-celiac pediatric controls.

Main Methods:

• A cohort of 665 children diagnosed with celiac disease (CD) and 348 age- and sex-matched gastroenterological controls were studied.
• Multiple endoscopic biopsies were obtained, including one from the duodenal bulb and four from the distal duodenum.
• Serological markers (anti-endomysium and anti-tissue transglutaminase antibodies) and human leukocyte antigen (HLA) genotypes were analyzed.

Main Results:

• Histological lesions consistent with celiac disease were identified in the duodenal bulb biopsies of all CD patients.
• In 16 children, these lesions were exclusively found in the duodenal bulb.
• No autoantibody positivity or CD-compatible mucosal changes were observed in the control group.

Conclusions:

• Duodenal bulb biopsies consistently reveal histological lesions in children with celiac disease.
• The duodenal bulb can be the sole site affected by CD-related lesions.
• Recommendations include obtaining two biopsies from the duodenal bulb and two from the distal duodenum for optimal CD diagnosis.