Importance of Duodenal Bulb Biopsy in Pediatric Patients for Diagnosis of Celiac Disease
Journal Title: International Journal of Medical Research Professionals - Year 2017, Vol 3, Issue 2
Abstract
Background: Celiac disease (CD) is a gluten-dependent enteropathy. It is a chronic gastrointestinal disorder in which ingestion of gluten, a protein present in wheat, rye and barley leads to damage of the small intestinal mucosa by an autoimmune mechanism in genetically susceptible individuals. 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. Objectives: To determine the role of the addition of duodenal bulb biopsies to distal duodenum (D2) biopsies in the diagnosis of celiac disease. Material & Methods: We enrolled 50 children prospectively who underwent upper gastrointestinal endoscopy because of positive tissue transglutaminase antibodies and biopsy as the final evaluation for suspected CD. One to four biopsies were taken from the descending duodenum distal and duodenal bulb of each patient. The histologic lesions were classified according to the Modified Marsh Oberhuber grade. Results: The diagnosis of CD was histologically confirmed in 96% (48/50) of the cases of biopsy samples obtained from the duodenal bulb and descending duodenum. In 28 patients (56%), histology was the same in the bulb and duodenum; in 7 (14%) cases, the grade of atrophy was higher in the bulb than the descending duodenum. 13 cases (26%) had a higher histological grade in the duodenum than in the bulb. Two patients had normal histology at both the sites. In none of the cases, the bulb biopsy was positive with negative distal duodenal biopsy for celiac disease. Conclusion: It is concluded the diagnostic yield from bulb biopsy is as good as biopsy taken from distal duodenum and hence could be substituted for D2 biopsy in pediatric patients.
Authors and Affiliations
Arpita Jindal, Pushpa Bairwa, Ranjana Solanki, Hema Udawat, R. K. Gupta`
Keywords
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- EP ID EP543784
- DOI 10.21276/ijmrp.2017.3.2.022
- Views 85
- Downloads 0
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