Endoscopic Duodenal Biopsies in Coeliac Disease and Duodenitis

Holdstock, G; Eade, O E; Isaacson, Peter G.; Smith, Carl C.

doi:10.3109/00365527909181943

Cited by 40 publications

(24 citation statements)

References 6 publications

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“…Compared with the distal duodenum, the bulb has more Brunner's glands and lymphoid tissue and may show gastric metaplasia. 11 The villi in the bulb may also be shorter and broader, 12,13 and some authors maintain that villi in the bulb may be blunted or even absent over Brunner's glands. 14,15 Furthermore, duodenitis from other causes can interfere with the interpretation of villous atrophy in this region.…”

Section: Discussionmentioning

confidence: 98%

Bulb biopsies for the diagnosis of celiac disease in pediatric patients

Mangiavillano

Masci

Parma

et al. 2010

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 98%

Bulb biopsies for the diagnosis of celiac disease in pediatric patients

Mangiavillano

Masci

Parma

et al. 2010

Gastrointestinal Endoscopy

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“…The bulb contains more Brunner's glands and lymphoid tissue and can have gastric metaplasia compared to the distal duodenum [7]. The villi may also be shorter and broader in this area [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…The patchy nature of the small intestinal lesion in celiac disease is increasingly being recognized both in children and adults [4,7,12-16]. The patchiness of lesion in various parts of the duodenum can be in terms of absence or presence of villous atrophy [4,12,13] or in the severity of atrophy [10].…”

Section: Discussionmentioning

confidence: 99%

Importance of duodenal bulb biopsies in children for diagnosis of celiac disease in clinical practice

Rashid

MacDonald

2009

BMC Gastroenterol

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BackgroundThe patchy nature of villous lesion in celiac disease is increasingly being recognized. Current guidelines recommend four endoscopic duodenal mucosal biopsies from the second or more distal part of the duodenum to confirm the diagnosis of celiac disease. The purpose of the study was to investigate the usefulness of duodenal bulb mucosal biopsies in confirming the diagnosis of celiac disease in everyday clinical practice.MethodsAll patients with a positive tissue-transglutaminase antibody requiring biopsy-confirmation of celiac disease over a two-year period were studied. Two endoscopic biopsies were taken from the duodenal bulb and four biopsies from the second (or distal) part of the duodenum.ResultsThirty-five patients were included, mean age 8.1 (± 4.7) years. Thirty-one (88.6%) patients had abnormal distal duodenal biopsies, one had Marsh type 1, one had Marsh type 2 and twenty-nine had Marsh type 3 lesion. All but two patients with abnormal distal duodenal biopsies also had abnormal bulb biopsies. Four (11.4%) patients had normal distal duodenal biopsies but abnormal bulb biopsies. Of these, one patient had Marsh type 2 and three had Marsh type 3 lesion. The distal duodenum was also grossly normal in these four patients. The histological diagnosis of celiac disease would not have been possible in these four cases with distal duodenal biopsies only.ConclusionThe lesion in celiac disease in children can be patchy with duodenal bulb mucosa being the only area showing histological changes. The recommendations regarding the site of biopsies should be revised to include biopsies not only from distal duodenum but also from bulb to improve the diagnostic yield.

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“…Histologic evidence of GSE depends on abnormalities in either architecture (villous blunting) or the number of IELs, or both 30,37 , 43,44 . Classically, GSE results in villous blunting consisting of short, widened villi or even totally flat intestinal mucosa.…”

Section: Mucosal and Mural Problemsmentioning

confidence: 99%

The pathology of malabsorption: current concepts

Owens

Greenson

2006

Histopathology

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Intestinal malabsorption results from a wide variety of causes, which can most easily be organized into three groups. Maldigestion arises from problems with mixing or with digestive mediators, and includes post-gastrectomy patients and those with deficiencies of pancreatic or intestinal enzymes, or of bile salts. Mucosal and mural causes of malabsorption are abundant, and include gluten-sensitive enteropathy, tropical sprue, autoimmune enteropathy, and HIV/AIDS-related enteropathy, as well as mural conditions such as systemic sclerosis. Finally, microbial causes of malabsorption include bacterial overgrowth, Whipple's disease, and numerous infections or infestations that are most frequently seen in immunocompromised patients. An overview of the most common and interesting entities in each of these categories follows, along with a discussion of current concepts. Mucosal conditions and microbial causes of malabsorption are given special attention.

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Endoscopic Duodenal Biopsies in Coeliac Disease and Duodenitis

Cited by 40 publications

References 6 publications

Bulb biopsies for the diagnosis of celiac disease in pediatric patients

Bulb biopsies for the diagnosis of celiac disease in pediatric patients

Importance of duodenal bulb biopsies in children for diagnosis of celiac disease in clinical practice

The pathology of malabsorption: current concepts

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