An approach to duodenal biopsies

Serra, Stefano; Jani, Prashant

doi:10.1136/jcp.2005.031260

Cited by 133 publications

(108 citation statements)

References 107 publications

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“…Para complementar a investigação laboratorial, em muitos casos, está indicada a realização da biópsia do intestino delgado para avaliação da arquitetura vilositária e do infiltrado inflamatório da lâmina própria para afastar causas específicas e para demonstrar a extensão do dano intestinal 34 .…”

Section: Diagnósticounclassified

Persistent diarrhea: still an important challenge for the pediatrician

Andrade¹,

Fagundes-Neto²

2011

J Pediatr (Rio J)

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Objective: To provide recent guidelines to reduce the incidence of diarrheal diseases. We discuss the definition, clinical aspects, pathophysiology, diagnosis, management, and prevention of persistent diarrhea.Sources: Electronic search of the MEDLINE database, Google search. Summary of the findings:Acute diarrhea may be caused by a variety of agents, including bacterial, viral, and protozoan pathogens. The top priority in treatment of diarrhea is replacement of fluid and electrolytes losses, particularly at the acute stage, and, under certain circumstances, eradication of the enteropathogenic agent. On the other hand, treatment of persistent diarrhea should focus on prevention and management of food intolerance and malnutrition.Conclusions: Promotion of breastfeeding, adequate interventions in the treatment of acute diarrheal episodes, introduction of safe dietary strategies for prevention of malnutrition, and improvements in sanitation and hygiene conditions, including sewage and clean water, are essential measures for the reduction of diarrheal morbidity and mortality rates in children under 5 years of age.J Pediatr (Rio J). 2011;87(3):199-205: Malnutrition, morbidity, mortality, diarrhea, food hypersensitivity, breastfeeding. ResumoObjetivo: Fornecer as diretrizes mais recentes de diminuição da incidência da doença diarreica, abordando os aspectos clínicos, a etiologia, a fisiopatologia, o diagnóstico, o manejo terapêutico e a profilaxia da diarreia persistente. Fontes dos dados:Busca eletrônica de dados recentes na base de dados MEDLINE, e também usando a ferramenta Google. Síntese dos dados:Existem vários possíveis agentes etiológicos envolvidos, incluindo vírus, bactérias e parasitas. O tratamento deve ser voltado para a dieta, além da reposição das perdas hidroeletrolíticas, especialmente durante a fase aguda da diarreia, para evitar seu prolongamento. Na grande maioria dos episódios, os antimicrobianos não estão indicados. Por outro lado, o tratamento da diarreia persistente deve ser reforçado no sentido de evitar as intolerâncias alimentares e a desnutrição. Conclusões:O estímulo ao aleitamento materno, a introdução de estratégias alimentares seguras no sentido de evitar a desnutrição proteico-calórica, a abordagem adequada do episódio agudo e a melhoria das condições sanitárias e de higiene são medidas a serem estimuladas com o objetivo de diminuir a morbimortalidade pela doença diarreica em crianças menores de 5 anos de idade ao redor do mundo.J Pediatr (Rio J). 2011;87(3):199-205: Desnutrição, morbidade, mortalidade, diarreia, hipersensibilidade alimentar, aleitamento materno.

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Section: Diagnósticounclassified

Persistent diarrhea: still an important challenge for the pediatrician

Andrade¹,

Fagundes-Neto²

2011

J Pediatr (Rio J)

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“…Of each well oriented, not crushed duodenal biopsy, the alcian blue/periodic acid Schiff (alcian blue/PAS) staining was carried out for DGM identification ( Figure 1B). For the purpose of the present study, DGM is defined by the presence of adjacent surface epithelial cells (in the apical portion or in the lateral side of the duodenal villous), without brush border and containing PAS-positive neutral mucin [13][14][15]. The DGM is classified as complete, incomplete, and intermediate, according to our criteria.…”

Section: Methodsmentioning

confidence: 99%

Histopathological Findings in Duodenal Biopsy of a Mexican Children Population with Gastritis by Helicobacter Pylori

A¹

2012

J Cytol Histol

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“…6 The normal villous to crypt ratio ranges from 3:1 to 5:1. 12 The villous epithelium is composed primarily of absorptive cells and goblet cells, with IELs between them. These are mainly CD3+ and CD8+ T lymphocytes, usually distributed in decrescendo-like pattern with higher count at the basis of the villi and decreasing towards the tip.…”

Section: Histopathological Changes In Celiac Diseasementioning

confidence: 99%

“…2 VA is defined as flattening of surface secondary to the shortening and blunting of the intestinal villi and is associated with an increase in crypt cell mitoses and crypt elongation. 12 To correctly assess VA in duodenal biopsy, good quality samples, properly oriented by qualified technician are essential. 2,12 Tangential sectioning and insufficient size of samples may lead to misinterpretation and overdiagnosis of VA. 26 Although CD is the most common cause of villous atrophy, there are many other conditions with similar histopathology.…”

Section: Villous Atrophymentioning

confidence: 99%

“…12 To correctly assess VA in duodenal biopsy, good quality samples, properly oriented by qualified technician are essential. 2,12 Tangential sectioning and insufficient size of samples may lead to misinterpretation and overdiagnosis of VA. 26 Although CD is the most common cause of villous atrophy, there are many other conditions with similar histopathology. 27 Therefore, in the absence of positive serology, this condition, defined as seronegative villous atrophy (SVA), should be further investigated.…”

Section: Villous Atrophymentioning

confidence: 99%

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Diagnostic challenges in celiac disease

et al. 2017

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Diagnosis of celiac disease in adults is currently based on serologic tests in combination with histopathological assessment of small intestinal biopsy specimens. High titers of celiac-specific antibodies in immunocompetent patients with villous atrophy in a good quality biopsy sample allow us to state a confident diagnosis. The relief of symptoms and histological improvement after embarking on a gluten free diet further support the initial diagnosis. However, in some cases, these conditions are not fulfilled, which requires a critical evaluation of laboratory and histopathology results and a consideration of other potential causes for the observed pathologies. To avoid diagnostic uncertainty, both biopsy and laboratory testing should be performed on a diet containing gluten. Immune deficiency, cross reaction of antibodies and possibilities of seronegative or latent celiac disease should be considered while evaluating serology results. Uneven distribution and variable intensity of histopathological changes in the small intestine along with multiple disorders presenting a similar specimen image may lead to invalid biopsy results. Additional laboratory testing and careful examination of a patient's history may deliver important data for a differential diagnosis and a more specific biopsy evaluation. Persistence or recurrence of symptoms, despite the ongoing treatment, requires a revision of the initial diagnosis, an evaluation of the gluten free diet and a search for concurrent disorders or complications.

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An approach to duodenal biopsies

Cited by 133 publications

References 107 publications

Persistent diarrhea: still an important challenge for the pediatrician

Persistent diarrhea: still an important challenge for the pediatrician

Histopathological Findings in Duodenal Biopsy of a Mexican Children Population with Gastritis by Helicobacter Pylori

Diagnostic challenges in celiac disease

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