It is well-recognized that obtaining a duodenal bulb biopsy increases the likelihood of making a diagnosis of celiac disease. Another study (PD Mooney et al. Gastroenterol 2016; 150: 1125-34) has tried to quantitate the frequency of “ultra-short” celiac disease (USCD).
In this prospective study of 1378 patients (mean age 50.3 yrs) who underwent endoscopy between 2008-2014, there was a cohort who had a high clinical suspicion of celiac disease in which quadrantic biopsies of the duodenal bulb were obtained.
- 268 (19.4%) were diagnosed with celiac disease
- 26 (9.7%) of celiac population had disease identified primarily in the duodenal bulb. These patients with USCD were younger (P=.03), had lower serologic titers of tissue transglutaminase antibody (tTG) (P=.001), and less frequently had diarrhea (P=.001).
- In USCD, the tTG titers were a median of 4.8x ULN compared with 20x ULN in those with more extensive disease.
- While the authors characterize 26 as having USCD, 19 of the 26 did have Marsh 1 (n=18, 69.2%) or Marsh 2 (n=1, 3.8%) lesions, indicating at least some involvement more distally. However, in these patients the duodenal bulb findings clinched the diagnosis.
Despite the protocol, the authors showed that a single biopsy from the bulb was sufficient to increase the diagnostic yield.
My take: This study reinforces the need for duodenal biopsies from both the bulb and more distally when the diagnosis of celiac disease is being considered.
Related blog posts:
- Taking One ‘Bite’ At A Time -For Celiac Diagnosis | gutsandgrowth
- Ten Things That Every Gastroenterologist Should Know – gutsandgrowth (about celiac disease)
- Expert review: Celiac disease | gutsandgrowth
- Duodenal IELs and the likelihood of celiac disease | gutsandgrowth
- Good Educational Two Minute Celiac Video | gutsandgrowth
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