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Related Experiment Video

Updated: May 9, 2026

Basic Three-Dimensional (3D) Intestinal Model System with an Immune Component

Basic Three-Dimensional (3D) Intestinal Model System with an Immune Component

Published on: September 1, 2023

Mapping histologic patchiness of celiac disease by push enteroscopy.

Francesco Valitutti¹, Giovanni Di Nardo¹, Maria Barbato¹

¹Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.

Gastrointestinal Endoscopy

|July 27, 2013

Summary

Celiac disease (CD) diagnosis can be challenging due to patchy lesions. Push enteroscopy helps identify CD in pediatric patients by evaluating small bowel lesions, especially when jejunal involvement is suspected.

Keywords:

CD ESPGHAN MO Marsh-Oberhuber The European Society for Paediatric Gastroenterology Hepatology and Nutrition celiac disease

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Published on: September 13, 2016

Area of Science:

Gastroenterology
Pediatric Gastroenterology
Diagnostic Endoscopy

Background:

Serologic testing for celiac disease (CD) has improved, but duodenal biopsies remain essential for diagnosis.
Histologic patterns of CD can be patchy, increasing the risk of missed diagnoses.
Conventional upper endoscopy may not adequately assess the entire small bowel for CD lesions.

Purpose of the Study:

To evaluate the patchiness and distribution of celiac disease (CD) histologic lesions throughout the small bowel (SB) using push enteroscopy.
To assess the diagnostic yield and accuracy of push enteroscopy in pediatric patients with suspected CD.
To compare findings from push enteroscopy with conventional biopsy sites.

Main Methods:

Prospective, single-center study involving 41 pediatric patients with suspected CD.
Push enteroscopy was used to obtain biopsy specimens from the bulb, duodenum, and jejunum.
Lesion distribution was analyzed from the bulb up to 60 cm beyond the ligament of Treitz.

Main Results:

A patchy pattern of histologic damage was observed in 58.5% of patients.
Lesions were frequently found in the bulb (90.2%), second (92.7%) and fourth (90.2%) duodenal regions, and jejunum (92.7%).
One patient was diagnosed with CD based solely on jejunal biopsies, highlighting the potential for exclusive jejunal involvement.

Conclusions:

Celiac disease (CD) histologic lesions often exhibit discontinuous distribution in the small bowel, with occasional exclusive jejunal involvement.
Push enteroscopy can be a valuable tool for re-evaluating potential CD cases that may have false-negative results due to missed jejunal lesions.
A high degree of villous atrophy correlates with elevated anti-transglutaminase titers.