Histopathologic Diagnosis of Celiac Disease in Children Without Clinical Evidence of Malabsorption

Abstract

Diverse clinical and pathologic experiences seem to have led to the idea that celiac disease is a spectrum in both categories. Conflicting results emerging from different reports have produced a large amount of confusion on the subject. This article discussed histopathology findings in 10 children with positive autoantibodies for celiac disease but without clinical evidence of malabsorption. The patients were evaluated following a detailed video-endoscopic study sampling the proximal (first and second) and distal (third and fourth) duodenal parts separately and processed apart. The procedure consistently revealed advanced villous atrophy in the proximal duodenal mucosa associated with mild to absent involvement of the distal segments. The data here presented favor the interpretation that (1) the presence of autoantibodies for celiac disease is always associated with mucosal damage, (2) mucosal damage in the absence of malabsorption is always evident in the proximal duodenum, and (3) the mucosal biopsy in search for the telltale damage needs to be done in separate samples of proximal and distal duodenal mucosa. This procedure may result in a better understanding of the dynamics of mucosal damage in celiac disease.

Diagnosing Celiac Disease: Role of the Pathologists

“…They showed in all patients advanced villous atrophy in the proximal duodenal mucosa and mild to absent involvement of the distal segments. They concluded that the presence of antibodies in the absence of malabsorption is always associated with mucosal damage, evident only in the proximal duodenum, and mucosal biopsy needs to be done in separate samples from proximal and distal duodenal mucosa [19]. More recent large scale studies in adult and pediatric patients confirmed that CD-related changes are always present in the duodenal bulb mucosa, and in some cases it is the only affected site [20,21].…”