Related Experiment Video
Updated: Jan 18, 2026
Assessment of Intestinal Transcytosis of Neonatal Escherichia coli Bacteremia Isolates
Published on: February 17, 2023
The Characteristics of Isolated Duodenal Bulb Coeliac Disease in Children: A Multicentre Retrospective Study
Eyal Zifman1,2, Jenni Berliand3, Bar Sofer4
1The Pediatric Gastroenterology Unit, Meir Medical Center, Kfar-Saba, Israel.
Insights
Isolated duodenal bulb coeliac disease in children is often missed. Lack of growth issues, low antibody levels, and no duodenal scalloping predict this specific form, highlighting the need for duodenal bulb biopsies in diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Celiac Disease Diagnostics
- Gastrointestinal Pathology
Background:
- Celiac disease diagnosis typically relies on distal duodenal biopsies.
- A subset of pediatric celiac disease patients exhibit pathology confined to the duodenal bulb.
- Identifying characteristics of isolated duodenal bulb celiac disease is crucial for accurate diagnosis in children.
Purpose of the Study:
- To characterize the baseline features of children with isolated duodenal bulb celiac disease.
- To compare these features with classic celiac disease presentations in pediatric patients.
Main Methods:
- Retrospective multicenter study involving pediatric patients diagnosed with celiac disease.
- Biopsies analyzed separately from the duodenal bulb and distal duodenum.
- Evaluation of demographic, anthropometric, clinical, associated diseases, and serological data.
Main Results:
- Out of 586 children, 127 (22%) had isolated duodenal bulb celiac disease.
- Classic celiac disease was associated with duodenal scalloping (OR 4.7), growth impairment (OR 2.7), and high anti-tissue transglutaminase (anti-tTG) levels (OR 4.5).
- Female sex and younger age were more common in the isolated duodenal bulb group.
Conclusions:
- Absence of growth impairment, anti-tTG levels <10x ULN, and lack of duodenal scalloping predict isolated duodenal bulb involvement.
- These findings underscore the importance of duodenal bulb biopsies during esophagogastroduodenoscopy for diagnosing celiac disease.
- Targeted biopsies of the duodenal bulb improve diagnostic yield in specific pediatric celiac disease cases.
Aim:
A minority of patients with coeliac disease have mucosal pathology limited to the duodenal bulb. We aimed to describe the baseline characteristics of isolated duodenal bulb coeliac disease in children.
Methods:
In this retrospective multicentre study of paediatric patients diagnosed with coeliac disease, based on biopsies obtained separately from the duodenal bulb and distal duodenum, we evaluated the demographic, anthropometric, clinical, associated diseases and coeliac serology characteristics of the patients.
Results:
Among the 586 children diagnosed with coeliac disease, 459 (78%) were classified as classic and 127 (22%) as isolated duodenal bulb coeliac disease-376 (64.2%) were female and the median age was 7 years (IQR 5-11). In multivariate logistic regression, scalloping of the duodenum (55.1% vs. 17.3%, p < 0.001, OR 4.7, 95% CI 2.8-8), growth impairment (9.8% vs. 9.4%, p = 0.012, OR 2.7, 95% CI 1.4-5.5) and baseline anti-tissue transglutaminase levels > 10 upper limit of norm (71.5% vs. 29.9%, p < 0.001, OR 4.5, 95% CI 2.8-7.2) were associated with a higher probability of having classic coeliac disease.
Conclusions:
Lack of growth impairment, anti-tissue transglutaminase levels <10 upper limit of norm and lack of duodenal scalloping are predictive of isolated duodenal bulb involvement, making duodenal bulb biopsies even more important during esophagogastroduodenoscopy for the diagnosis of Celiac disease. [Correction added on 08 September 2025, after first online publication: The preceding sentence was corrected.].
Related Concept Videos
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:27Histology of the Small Intestine
The intestinal lining features transverse folds called circular folds, each housing fingerlike projections known as intestinal villi. These villi are covered by a layer of simple columnar epithelium, also referred to as...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...