Bulb biopsies for the diagnosis of celiac disease in pediatric patients

Benedetto Mangiavillano, Enzo Masci, Barbara Parma, Graziano Barera, Paolo Viaggi, Luca Albarello, Giulia Maria Tronconi, Alberto Mariani, Sabrina Testoni, Tara Santoro, Pier Alberto Testoni

Research output: Contribution to journalArticlepeer-review


Background: Celiac disease (CD) is a gluten-dependent enteropathy. The current standard for diagnosing CD involves obtaining 4 biopsy samples from the descending duodenum. It has been suggested that duodenal bulb biopsies may also be useful. Objective: To assess the utility of bulbar biopsies for the diagnosis of CD in pediatric patients. Design: Prospective study. Setting: Single center. Patients: Forty-seven consecutively enrolled pediatric patients with celiac serologies and a clinical suspicion of CD. Interventions: All patients underwent EGD, and 4 biopsy samples were obtained from the duodenal bulb and 4 from the descending duodenum of each child. Main Outcome Measurements: The pathologist blindly reported the Marsh histological grade for the diagnosis of CD of the bulb and descending duodenum. Results: The diagnosis of CD was histologically confirmed in 89.4% (42/47) of the cases of biopsy samples obtained from the descending duodenum and in all 47 obtained from the bulb. In 35 patients (74.5%), histology was the same in the bulb and duodenum; in 11 (23.4%) cases, the grade of atrophy was higher in the bulb than in the descending duodenum, and 5 (10.6%) had bulb histology positive for CD but negative duodenal findings. One child (2.1%) had a higher histological grade in the duodenum than in the bulb. The diagnostic gain with bulbar biopsies was 10.6%. Limitations: Small sample and absence of a comparison group (asymptomatic children with normal CD antibodies). Conclusions: We suggest examining 4 biopsy samples from the duodenal bulb and 4 from the descending duodenum to improve diagnostic accuracy of CD.

Original languageEnglish
Pages (from-to)564-568
Number of pages5
JournalGastrointestinal Endoscopy
Issue number3
Publication statusPublished - Sep 2010

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging


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