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Variability of histopathological changes in childhood celiac disease
Dascha C Weir1, Jonathan N Glickman, Tracey Roiff
1Department of Pathology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. dascha.weir@childrens.harvard.edu
Insights
Pediatric celiac disease (CD) often shows patchy duodenal biopsy findings, with variability even within single samples. Obtaining multiple biopsies, including from the duodenal bulb, is crucial for accurate diagnosis in children.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Adult celiac disease (CD) studies indicate patchy duodenal histopathology.
- The diagnostic value of duodenal bulb biopsies in pediatric CD is not well-established.
Purpose of the Study:
- To evaluate biopsy finding variability and duodenal bulb involvement in pediatric CD.
- To correlate these findings with clinical parameters.
Main Methods:
- Analysis of 198 pediatric CD cases diagnosed between 2001-2005.
- Pathological scoring using Marsh criteria by a blinded pathologist.
- Classification of focality and patchiness based on biopsy fragment variations.
Main Results:
- Patchiness observed in 53% of cases; focality in 18%.
- Normal mucosa found in 36% of biopsy sets.
- Duodenal bulb biopsies were diagnostic in 10 cases.
- No association found between biopsy variability and clinical features.
Conclusions:
- Pediatric CD frequently exhibits patchy duodenal involvement with variable severity.
- Clinical characteristics do not predict biopsy variability.
- Multiple biopsies, including the duodenal bulb, are recommended for maximizing diagnostic yield in suspected pediatric CD.
Objectives:
Adult studies of celiac disease (CD) have shown that duodenal mucosal histopathological changes may be patchy, and the diagnostic utility of duodenal bulb biopsies is believed to be limited. Few related pediatric data exist.
Methods:
We assessed the prevalence of variable biopsy findings and duodenal bulb involvement in children with CD, as well as its association with clinical parameters. A total of 198 consecutive cases of CD diagnosed at the Children's Hospital during 2001-2005 were analyzed. All biopsies were scored by a pathologist blinded to the clinical data using the Marsh criteria. Mucosal changes were classified as focal if changes consistent with CD and normal mucosa were found within a single biopsy fragment. Patchiness was defined as variation of at least one Marsh grade between separate fragments in a biopsy set.
Results:
The median age was 9.3 years; 62% were female. An average of 3.6 biopsy samples was obtained per case. In 101 cases, biopsy samples were obtained from the duodenal bulb and the second portion of the duodenum. Focality was present in biopsy samples collected from 36 (18%) cases. Patchiness was found in 105 (53%) cases, and at least 1 normal biopsy fragment was present in 71 (36%) cases. In 10 cases, only the bulb biopsies were diagnostic of CD. There was no association with the clinical features examined.
Conclusions:
Duodenal involvement in pediatric CD is frequently patchy and may show variable severity even within a single biopsy fragment. Variability cannot be predicted by clinical characteristics. Multiple endoscopic biopsies, including the duodenal bulb, should be obtained in suspected pediatric CD cases to maximize diagnostic yield.
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