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Patchy Villous Atrophy of the Duodenum in Childhood Celiac Disease

Bonamico, Margherita*; Mariani, Paolo*; Thanasi, Enina*; Ferri, Mirella*; Nenna, Raffaella*; Tiberti, Claudio; Mora, Barbara; Mazzilli, Maria Cristina; Magliocca, Fabio Massimo

Journal of Pediatric Gastroenterology and Nutrition: February 2004 - Volume 38 - Issue 2 - p 204-207
Original Articles—Gastroenterology

Objectives Patchy villous atrophy of the duodenal mucosa has been described in adults with untreated celiac disease (CD) but not in children. The authors evaluated the presence and the distribution of villous atrophy in children with celiac disease to see whether this histologic pattern exists in children.

Methods We studied 95 children at diagnosis (Group 1) and seven during gluten challenge (Group 2). We measured anti-endomysium antibodies (EMA) by immunofluorescence on monkey esophagus, antihuman-tissue transglutaminase autoantibodies (anti-tTG Abs) by radioimmunoprecipitation, and HLA-DQ2/DQ8 heterodimers by polymerase chain reaction using specific primers. During upper intestinal endoscopy, at least five duodenal biopsy samples were obtained, one from the duodenal bulb and four from the distal duodenum.

Results Thirteen of 95 (13.7%) patients in Group 1 and in 3 of 7 (42.9%) in Group 2 had patchy villous atrophy of the duodenum. In all 16 patients, villous atrophy of the bulb was present. In four children from Group 1, villous atrophy was observed only in the bulb samples. EMA, anti-tTG Abs, and HLA-DQ2/DQ8 heterodimers were present in all patients. Fourteen of 16 had symptomatic CD, and two were silent, detected during screening in subjects at risk for CD.

Conclusions This is the first study demonstrating that children with CD may have patchy villous atrophy of the duodenum. The bulb mucosa may be the only duodenal area involved, both at diagnosis and after gluten challenge. Therefore, multiple endoscopic biopsies should always be performed, not only in the distal duodenum, but also in the bulb.

Departments of *Pediatrics, †Experimental Medicine and Pathology, and ‡Clinical Sciences, University of Rome “La Sapienza,” Rome, Italy

Received: August 28, 2003; accepted: September 8, 2003.

Address correspondence and reprint requests to Professor Margherita Bonamico, Pediatric Clinic, University of Rome “La Sapienza,” Policlinico “Umberto I,” Viale Regina Elena, 324 00161 Rome, Italy (e-mail:

Supported by a grant from the Ministero dell'Università, dell'Istruzione e della Ricerca (MUIR).

© 2004 Lippincott Williams & Wilkins, Inc.