Bulb biopsies for the diagnosis of celiac disease in pediatric patients

Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?

“…22 A recent pediatric study suggested that 4 biopsy specimens are required from the duodenal bulb in addition to specimens from the distal duodenum to optimize the diagnostic accuracy of celiac disease. 23 To our knowledge, no such study has been undertaken in an adult population. The aim of this study was to assess whether duodenal bulb biopsies in addition to distal duodenal biopsies increased the diagnostic yield of celiac disease in patients undergoing EGD and duodenal biopsy.…”

Predictors of duodenal bulb biopsy performance in the evaluation of coeliac disease in children

“…The characteristic change with increased intraepithelial lymphocytes, crypt hyperplasia and villous atrophy (ie, Marsh III) can present exclusively in the duodenal bulb with a normal villous morphology in the descending duodenum with wide-ranging percentages across studies among paediatric and adult CD patients 4 7 10 11 18 19. Bonamico and colleagues in 200412 first demonstrated that all study children with positive CD serology and villous atrophy had lesions in the duodenal bulb, and 4% had positive biopsy only in the bulb.…”

“…Recent evidence demonstrates that patchiness and focality of CD can be observed in both children and adults 4–9. Furthermore, research investigations on the role of duodenal bulb biopsy (DBB) in CD evaluation have been greatly increased over the past 5 years 4 7 10 11. Several studies have shown that most CD patients had positive biopsy in the duodenal bulb4 9 11 and that CD can present solely in the duodenal bulb (with a normal villous morphology in the more distal duodenum) in 2%–10% of children 4 7 10–12.…”

Diagnostic dilemmas in celiac disease

“…Notably, the diagnostic accuracy reduces to 90-95% if only two or three biopsy specimens are obtained [23]. There is growing evidence that routine duodenal bulb biopsy, in addition to distal biopsies, increases the detection of villous atrophy by 9-13% [24][25][26]. Given the patchy nature of villous atrophy, high-resolution magnification endoscopy has also been used to improve detection of mucosal abnormalities [27].…”