Prospective study of the role of duodenal bulb biopsies in the diagnosis of celiac disease

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

“…However, recent studies demonstrated that macroscopic changes in celiac disease do occur in the duodenal bulb and in some patients (1.8%-14%) may be the only site of villous atrophy. [13][14][15][16][17][18][19][20] These findings support our group's previous work in which patchy villous atrophy was identified within the duodenum in patients with glutensensitive enteropathy. 20 The rationale in taking duodenal bulb biopsy specimens could be substantiated by a conventional understanding that villous atrophy is most severe proximally where the gluten load is greatest.…”

“…Another potential limitation of our work is that when compared with a recent study in which biopsy orientation caused potential histopathological interpretation problems, 15 our study failed to demonstrate this as a significant issue with all biopsies deemed suitable for assessment. Although the cause of this difference is not entirely clear, it may reflect endoscopist-related factors such as proficiency in taking adequate biopsy specimens, the number of samples taken, or the expertise of our local histopathology technicians.…”

Clinical and Immunologic Features of Ultra-Short Celiac Disease

“…[8][9][10][11][12] However the practice of D1 biopsy has not been universally accepted. Indeed, in a recent audit of non-specialist hospitals in the UK, a D1 biopsy was performed in only 18/914 (2.0%) of patients undergoing duodenal biopsy to diagnose celiac disease and only in 10% of patients in a recent US study.…”

“…However D1 had been avoided as a possible biopsy site due to concerns over the difficulty in interpretation due to the B reduced villous height. 9 Prospective data from a heterogeneous group of small studies has suggested that interpretation of D1 biopsies is possible and may be the only site of villous atrophy in newly diagnosed celiac disease, (ultra-short celiac disease, (USCD)) ( Table 1). [8][9][10][11][12][13] D1 biopsy however is not yet fully accepted for several reasons.…”

Detection of Villous Atrophy Using Endoscopic Images for the Diagnosis of Celiac Disease

“…Further refinement of image enhancement or computerized quantification techniques should improve identification of images with lesser degrees of villous atrophy. It is only then that image enhancement techniques could possibly replace direct biopsy [30,31] in the diagnosis of celiac disease.…”