The frequency and characteristics of ultra-short celiac disease in children: A single-center experience
Yasin Sahin1,2, Ahmet Uzger3, Ahmet Rauf Goktepe3
1Department of Pediatric Gastroenterology, Faculty of Medicine, Gaziantep Islam Science and Technology University, 27560, Gaziantep, Turkey. ysahin977@gmail.com.
Purpose:
Due to the patchy nature of mucosal involvement in Celiac disease (CD), histopathological changes may be confined to the duodenal bulb in some patients, leading to diagnostic challenges. This study aimed to investigate the frequency, as well as the clinical and serological characteristics, of ultra-short celiac disease (USCD) in children.
Methods:
Between February 2024 and March 2026, pediatric patients diagnosed with CD based on separate biopsy specimens obtained from the duodenal bulb and distal duodenum, each placed in separate containers, were enrolled in this study. The patients were classified into two groups: the USCD group and the classic CD group.
Results:
Of the 78 patients included, 47 (60.25%) were female, and the overall mean age at diagnosis was 9.58 ± 4.21 years. The median tissue transglutaminase IgA (tTG-IgA) level was 125.50 (IQR: 21.30-200.00) IU/L. Sixteen patients (20.51%) had histopathologically confirmed USCD. The median tTG-IgA level was significantly lower in the USCD group compared to the classic CD group (22.50 vs. 162.00 IU/L; p < 0.05). Additionally, 87.50% of the patients in the USCD group lacked the classic gastrointestinal symptoms typically associated with malabsorption, presenting instead with isolated growth retardation.
Conclusion:
The rate of isolated duodenal bulb involvement in children was remarkably high (20.51%). Ultra-short celiac disease is more prevalent in pediatric patients presenting with fewer classic gastrointestinal findings and tTG-IgA levels below 10 × ULN. Therefore, it is critically important to obtain at least one biopsy specimen from the duodenal bulb and place it in a separate container. Missing bulb biopsies may result in a significant proportion of patients with isolated duodenal bulb involvement going undiagnosed. What is known • The frequency of ultra-short celiac disease (USCD) varies between 2.4% and 22.0% for more accurate differentiation • Intestinal biopsy remains mandatory to diagnose CD in patients with tTG-IgA levels below 10 times the upper limit of normal (10 × ULN) • Duodenal bulb biopsies are not routinely performed even in specialized centers during endoscopy What is new • The frequency of USCD in children with CD was found to be relatively high (20.51%) • Among patients with USCD, 75.00% exhibited tTG-IgA levels below 10 × ULN • Systematic duodenal bulb biopsy substantially enhances USCD detection in patients with low tTG-IgA levels; without it, approximately one in five patients may remain undiagnosed.
