© Georg Thieme Verlag Stuttgart · New York
Diagnostic Duodenal Bulb Biopsy in Celiac Disease
31 December 2001 (online)
Background and Study Aims: Duodenal or jejunal biopsies are needed to establish the diagnosis of celiac disease. It is widely advocated that these biopsies be taken from the distal duodenum.
Patients and Methods: After finding two index cases with diagnostic biopsies taken from the duodenal bulb, we retrospectively analyzed biopsies from the descending duodenum and the duodenal bulb of 51 patients with suspected or diagnosed celiac disease. The diagnosis of celiac disease and classification of the histological changes were performed by one pathologist.
Results: In the two index cases the diagnosis of celiac disease could only be established by taking the biopsies from the duodenal bulb, and not from the descending duodenum. In the retrospective analysis the number of intraepithelial lymphocytes was on average higher, but not significantly, in the descending part of the duodenum.
Conclusions: Most patients with celiac disease show similar mucosal changes in biopsies taken from the descending part of the duodenum and from the duodenal bulb. But in patients who have already been on a gluten-free diet in childhood and later abandoned their diet, an additional duodenal bulb biopsy should be done.
- 1 Rubin C E, Dobbins W O. Peroral biopsy of the small intestine. Gastroenterology. 1965; 49 676-697
- 2 Gillberg R, Ahren C. Coeliac disease diagnosed by means of duodenoscopy and endoscopic duodenal biopsy. Scand J Gastroenterol. 1977; 12 911-916
- 3 Gillberg R, Kastrup W, Mobacken H, et al. Endoscopic duodenal biopsy compared with biopsy with the Watson capsule from the upper jejunum in patients with dermatitis herpetiformis. Scand J Gastroenterol. 1982; 17 305-308
- 4 Saverymuttu S H, Sabbat J, Burke M, et al. Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy. Postgrad Med J. 1991; 67 47-49
- 5 Scott B B, Losowsky M S. Patchiness and duodenal-jejunal variation of the mucosal abnormality in coeliac disease and dermatitis herpetiformis. Gut. 1976; 17 984-992
- 6 Shidrawi R G, Przemioslo R, Tighe D R, et al. Pitfalls in diagnosing coeliac disease. J Clin Pathol. 1994; 47 693-694
- 7 Branski D, Faber J, Freier S, et al. Histologic evaluation of endoscopic versus suction biopsies of small intestinal mucosae in children with and without celiac disease. J Pediatr Gastroenterol Nutr. 1998; 27 6-11
- 8 Walker-Smith J A, Guandalini S, Schmitz J, et al. Revised criteria for diagnosis of coeliac disease. Arch Dis Child. 1990; 65 909-911
- 9 Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999; 11 1185-1194
- 10 Manuel P D, Walker-Smith J A, France N E. Patchy enteropathy in childhood. Gut. 1979; 20 211-215
- 11 Smecuol E, Maurino E, Vazquez H, et al. Gynaecological and obstetric disorders in coeliac disease: frequent clinical onset during pregnancy or the puerperium. Eur J Gastroenterol Hepatol. 1996; 8 63-67
H. Vogelsang, M.D.
IV Dept. of Medicine
Dept. of Gastroenterology and Hepatology
Währinger Guertel 18 - 20
Fax: Fax:+ 43-1-40400-4735