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Duodenal Bulb Biopsies in Celiac Disease: A Multicenter Study

Bonamico, Margherita*; Thanasi, Enina*; Mariani, Paolo*; Nenna, Raffaella*; Luparia, Rita Pia Lara*; Barbera, Cristiana; Morra, Isabella; Lerro, Pietro; Guariso, Graziella; De Giacomo, Costantino§; Scotta, Serenella; Pontone, Stefano||; Carpino, Francesco**; Magliocca, Fabio Massimo**; and the Società Italiana di Gastroenterologica, Epatologia, e Nutrizione Pediatrica

Journal of Pediatric Gastroenterology & Nutrition: November 2008 - Volume 47 - Issue 5 - p 618–622
doi: 10.1097/MPG.0b013e3181677d6e
Original Articles: Gastroenterology

Objectives: Celiac disease (CD)–related lesions have been reported in duodenal bulb biopsies, sometimes the bulb mucosa being the only one affected. The aim was to verify in a significant series whether histological lesions are always present in the bulb of celiac patients, what is the prevalence of lesions when isolated to the bulb, and if similar lesions are present in nonceliac subjects.

Methods: We studied 665 children with CD (241 males, range 9 months–15 years, 8 months), at diagnosis on a gluten-containing diet, and 348 age- and sex-matched gastroenterological controls submitted to upper endoscopy for gastroenterological complaints. During endoscopy, multiple biopsies (1 bulb and 4 distal duodenum samples) were taken. Anti-endomysium antibodies were evaluated by immunofluorescence method, anti–human tissue–transglutaminase antibodies by an enzyme-linked immunosorbent assay or radioimmunoassay. Human leukocyte antigen-DRB1, -DQA1, and -DQB1 genes were typed by polymerase chain reaction sequence–specific primers repeat method.

Results: In all of the patients with CD, histological lesions were present in the bulb sample; in 16 of them, the lesions were present only in the bulb. Patchy villous atrophy was found in 20 children. All of the patients with CD were anti-endomysium and/or anti-transglutaminase positive. The controls showed neither autoantibody positivity nor mucosal changes compatible with CD.

Conclusions: This study demonstrated that CD-related histological lesions are always present in the bulb; sometimes this specific site is the only one affected. Therefore, we suggest taking 2 biopsies from the bulb and 2 from the distal duodenum for CD diagnosis.

*Departments of Paediatrics, University “La Sapienza” of Rome, Italy

University of Turin, Italy

University of Padua, Italy

§Niguarda Hospital of Milan, Italy

S. Antonio Abate Hospital of Gallarate, Italy

††University of Naples Federico II, Italy

‡‡University of Trieste, Italy

§§University of Messina, Italy, Italy

||Departments of Surgical Sciences, Italy

**Experimental Medicine and Pathology, University “La Sapienza” of Rome, Rome, Italy

Received 28 May, 2007

Accepted 26 January, 2008

Address correspondence and reprint requests to Margherita Bonamico, MD, PhD, Dipartimento di Pediatria, Via le Regina Elena 324, Rome 00161, Italy (e-mail:

Società Italiana di Gastroenterologica, Epatologia, e Nutrizione Pediatrica members are Clara Perricone, Antonella Castronovo, Silvia Conte, Sabrina Pigni, Erasmo Miele, Stefano Martelossi, and Concetta Sferlazzas.

Supported, in part, by grant C26A052433 2000–2004, “Anticorpi anti-transglutaminasi tissutale nella diagnosi e nel follow-up della malattia celiaca,” from the Italian University Public Education and Research Ministry, and by Italian Health Ministry grant ICS030.2/RF00.259 2001–2002, “Celiachia: sviluppo di linee guida per lo screening e la diagnosi e studio dei meccanismi patogenetici.”

The authors report no conflicts of interest.

© 2008 Lippincott Williams & Wilkins, Inc.