Coeliac disease is an autoimmune condition with variable presentation which leads to difficulties and delays in diagnosis. A retrospective study was undertaken to investigate the effectiveness of duodenal bulb biopsies in histologic diagnosis of coeliac disease. Histology specimens were analysed from 230 patients, age ranging from 0 to 16 years over a 10-year period (2014–2024) who had raised tissue transglutaminase/endomysial antibodies and were referred for an upper gastrointestinal endoscopy to confirm/rule out coeliac disease. Biopsies taken from the proximal (D1) and distal duodenum (D2, 3, 4) were compared in 145 children who were confirmed to have the diagnosis of coeliac disease on histopathology. The results revealed that a significant number of children (56/145; 38.6%) had positive histological changes seen in proximal duodenum only with completely normal histology in distal duodenum. In comparison, only 4/145 (2.8%) children yielded positive histology result from distal duodenum with normal proximal duodenal biopsies. Proximal duodenal segment histology samples therefore had the highest sensitivity (97%), negative predictive value (95.5%), and accuracy (98%). Conclusion: Our fundings re-enforce the importance of obtaining an adequate number of proximal duodenal samples for histological analysis in children investigated for coeliac disease in order to avoid delayed or missed diagnosis in this age group. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> What is Known: • Coeliac disease affects 1–2% of western population though prevalence varies by the region. • A sub-set of suspected cases with anti-tissue transglutaminase (TTG) antibody titres of less than ten times the upper limit of normal require duodenal biopsies for confirmation of diagnosis. </entry> </row> <row> <entry align="left" nameend="c2" namest="c1"> What is New: • Duodenal bulb biopsies have higher sensitivity and negative predictive value when compared to distal duodenal biopsies. • Endoscopist must obtain adequate number of samples from proximal duodenum (duodenal bulb) to avoid false negative results. </entry> </row> </tbody> </tgroup> </Table>

Effectiveness of duodenal bulb biopsies in histological diagnosis of coeliac disease

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发表日期：

2025年4月2日

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M. Ahmed,
T. Tolufase,
P. Gill,
M. I. Sayed

摘要

Coeliac disease is an autoimmune condition with variable presentation which leads to difficulties and delays in diagnosis. A retrospective study was undertaken to investigate the effectiveness of duodenal bulb biopsies in histologic diagnosis of coeliac disease. Histology specimens were analysed from 230 patients, age ranging from 0 to 16 years over a 10-year period (2014–2024) who had raised tissue transglutaminase/endomysial antibodies and were referred for an upper gastrointestinal endoscopy to confirm/rule out coeliac disease. Biopsies taken from the proximal (D1) and distal duodenum (D2, 3, 4) were compared in 145 children who were confirmed to have the diagnosis of coeliac disease on histopathology. The results revealed that a significant number of children (56/145; 38.6%) had positive histological changes seen in proximal duodenum only with completely normal histology in distal duodenum. In comparison, only 4/145 (2.8%) children yielded positive histology result from distal duodenum with normal proximal duodenal biopsies. Proximal duodenal segment histology samples therefore had the highest sensitivity (97%), negative predictive value (95.5%), and accuracy (98%).

Conclusion: Our fundings re-enforce the importance of obtaining an adequate number of proximal duodenal samples for histological analysis in children investigated for coeliac disease in order to avoid delayed or missed diagnosis in this age group.

What is Known:

• Coeliac disease affects 1–2% of western population though prevalence varies by the region.

• A sub-set of suspected cases with anti-tissue transglutaminase (TTG) antibody titres of less than ten times the upper limit of normal require duodenal biopsies for confirmation of diagnosis.

What is New:

• Duodenal bulb biopsies have higher sensitivity and negative predictive value when compared to distal duodenal biopsies.

• Endoscopist must obtain adequate number of samples from proximal duodenum (duodenal bulb) to avoid false negative results.