Bulb biopsies for the diagnosis of celiac disease in pediatric patients

BackgroundCeliac disease (CD) is a gluten-dependent enteropathy. The current standard for diagnosing CD involves obtaining 4 biopsy samples from the descending duodenum. It has been suggested that duodenal bulb biopsies may also be useful.ObjectiveTo assess the utility of bulbar biopsies for the diagnosis of CD in pediatric patients.DesignProspective study.SettingSingle center.PatientsForty-seven consecutively enrolled pediatric patients with celiac serologies and a clinical suspicion of CD.InterventionsAll patients underwent EGD, and 4 biopsy samples were obtained from the duodenal bulb and 4 from the descending duodenum of each child.Main Outcome MeasurementsThe pathologist blindly reported the Marsh histological grade for the diagnosis of CD of the bulb and descending duodenum.ResultsThe diagnosis of CD was histologically confirmed in 89.4% (42/47) of the cases of biopsy samples obtained from the descending duodenum and in all 47 obtained from the bulb. In 35 patients (74.5%), histology was the same in the bulb and duodenum; in 11 (23.4%) cases, the grade of atrophy was higher in the bulb than in the descending duodenum, and 5 (10.6%) had bulb histology positive for CD but negative duodenal findings. One child (2.1%) had a higher histological grade in the duodenum than in the bulb. The diagnostic gain with bulbar biopsies was 10.6%.LimitationsSmall sample and absence of a comparison group (asymptomatic children with normal CD antibodies).ConclusionsWe suggest examining 4 biopsy samples from the duodenal bulb and 4 from the descending duodenum to improve diagnostic accuracy of CD.