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    Duodenal Bulb is Shown to be the Best Place to Find Villous Atrophy


    Diana Gitig Ph.D.
    Image Caption: Photo: CC- Spirit-Fire

    Celiac.com 09/23/2011 - Despite the current sensitivity and specificity of blood tests, a small bowel biopsy showing villous atrophy remains the international gold standard for diagnosing celiac disease. Yet the small intestine is actually quite long, and villous atrophy can be dispersed throughout and therefore potentially missed, especially in children. Experts recommend that at least four tissue samples be taken to circumvent this problem, but have not specified the optimal sites from which to take the samples.


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    CC- Spirit-FireJejunal biopsies have historically been performed, but they are uncomfortable for the patient and technically complicated. Duodenal biopsies are safer and easier, and there is even some data suggesting that the duodenal bulb may be the only site of villous atrophy in patients newly diagnosed with celiac disease. Yet it was not known whether biopsy of the duodenal bulb alone would be sufficient to identify established celiac disease in adult patients. A recent study aimed to compare histology of the duodenal bulb in adults with newly diagnosed celiac disease, established celiac disease, and no celiac disease. They found that villous atrophy may in fact only be present in the duodenal bulb, and that this is therefore the optimal site for biopsy in diagnosing celiac disease.

    Four hundred and sixty-one patients were analyzed, with a mean age of 51 years. They were recruited from a hospital in the United Kingdom between November 2008 and July 2010. Three hundred were women and one hundred and sixty-one were men. One hundred and twenty-six were newly diagnosed with celiac disease; eighty-five had established celiac disease, had been adhering to a gluten free diet, and were undergoing biopsy to histologically assess their remission; and two hundred and fifty were healthy controls. Five biopsies were taken from each patient: one from the duodenal bulb and four from the second part of the duodenum, one from each quadrant. Twenty-three patients exhibited villous atrophy only in the duodenal bulb, and both new and established celiac cases were significantly more likely to exhibit this phenomenon than controls. Most of the patients with lesions of varying severity at different locations had the more severe lesion in the duodenal bulb. Similar results have been achieved with children in other studies.

    The researchers note that their results are support and are supported by the literature, and conclude that "the optimal strategy for diagnosing celiac disease could only achieve 100% sensitivity by always incorporating a duodenal bulb biopsy."

    Source:

    • Evans KE, Aziz I, Cross SS, Sahota GR, Hopper AD, Hadjivassiliou M, Sanders DS. A Prospective Study of Duodenal Bulb Biopsy in Newly Diagnosed and Established Adult Celiac Disease. Am J Gastroenterol. 2011 May 24.
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    Guest Lilyan Barrett

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    Great information! The more we learn about celiac diagnosis procedures and improvements in detection methods the better.

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  • About Me

    Diana received her B.A. in Biochemistry from the University of Pennsylvania, and then a Ph.D. in Cell Biology and Genetics from Cornell. Now she is a freelance science writer and editor in White Plains, New York.  Her son was diagnosed with celiac disease in 2006, at the age of five, and she has been keeping her family healthy by feeding them gluten free treats ever since.

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  • Related Articles

    Scott Adams
    Celiac.com 12/12/2004 - A new study that was presented on November 1, 2004 by Julian Abrams, MD, and colleagues from Columbia University Medical Center in New York City at the American College of Gastroenterology (ACG) 69th Annual Scientific Meeting indicates that using only antibody to tissue transglutaminase (tTG) to diagnose celiac disease will likely result in missed diagnoses—and the accuracy of the tTG results depends on which lab conducts the test. Many clinical studies during the past few years have indicated that tTG testing is as accurate as endomyosial antibody (EMA), which has caused many labs to use tTG rather than EMA, and even the recent National Institutes of Health Consensus Conference on Celiac Disease advocated the use of tTG over EMA.
    In the study the researchers evaluated the effectiveness of tTG in a general referral practice medical setting by reviewing 137 patients who had duodenal biopsy and tTG testing for celiac disease, out of which 117 were biopsy confirmed. Serum from these individuals was sent to four different commercial laboratories for analysis, and the results from these labs were compared. The average tTG sensitivity overall was 71% with a specificity of 67%. In patients with total villous atrophy sensitivity was as high as 92%, and in those with only partial villous atrophy it was as low as 38%. One of the four laboratories tested samples from 48 of the patients and their sensitivity was only 51%, while the specificity was 100%.
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    Jefferson Adams
    Celiac.com 11/18/2009 - Clinical studies of adults with celiac disease have shown that duodenal mucosal histopathological changes may be patchy, and the diagnostic value of duodenal bulb biopsies is thought to be limited. Very little data exist regarding how this applies to children with celiac disease.
    A team of researchers recently set out to assess the prevalence of variable biopsy findings and duodenal bulb involvement in children with celiac disease, as well as its association with clinical parameters.
    The research team was made up of Dascha C. Weir MD, Jonathan N. Glickman MD, Tracey Roiff, Clarissa Valim MD, ScD, and Alan M. Leichtner MD. The team analyzed the prevalence of variable biopsy findings and duodenal bulb involvement in children with celiac disease, together with its association with clinical parameters.
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    They classified 36 biopsy samples (18%) as focal. They classified 105 samples (53%) as 'patchy', with at least 1 normal biopsy fragment was present in 71 cases (36 %). In 10 cases, researchers made reliable diagnosis only via bulb biopsy. There was no association with the clinical features examined.
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    Source:
    Am J Gastroenterol  6 October 2009; doi: 10.1038/ajg.2009.557


    Destiny Stone
    Celiac.com 03/11/2010 - Many people are confused about which tests provide the most accurate results for a celiac disease diagnosis. In a recent study by a team at the Department of Gastroenternology and Internal Medicine, St. Orsola-Malpigihi Hospital, University of Bologna, Bologna, Italy, researchers evaluated  current testing methods, and made some conclusions about celiac testing that may shed light on the subject for those of us overwhelmed by current conflicting information.
    Duodenal biopsy is considered to be the universal 'gold standard' for celiac diagnosis. However, in recent years the importance of  serological testing has been been emphasized as a reliable marker for antibodies as well. The tTG antibodies of IgA class are currently recognized to be the most effective test for celiac screening, resulting in up to 95% accuracy.  Although, a new serological test, DGP, is now being investigated as a more reliable alternative to tTG.
    A study was devised to compare the effectiveness of DGP antibodies with that of tTG antibodies, and used a meta-analysis of  eleven studies that were published between 1998 and 2008. The study analyzed the results of 937 patients with untreated celiac, and 1,328 control subjects. The analysis of the eleven studies showed that IgA tTG antibodies revealed a higher likelihood ratio (LR) than IgA DGP antibodies, and IgA tTG antibodies exhibited a lower LR than IgA DGP antibodies. The data between the two antibody tests validates that IgA tTG continues to display the most accurate diagnostic tests for a positive celiac diagnosis, as well as for excluding a negative celiac diagnosis.  However  IgG DGP antibody tests were shown to be more effective at identifying 'false negatives' and had more success in determining celiac in patients that had IgA deficiency, and in children under two years old.
    The results of these tests clearly demonstrate that IgA DGP does not offer any advantages to the IgA tTG antibodies, and is actually less accurate and more expensive. However, IgG  DGP antibodies present an invaluable tool  in screening for celiac disease in cases where IgA tTG tests fail. Eventually, a new antibody screening will hopefully be designed which combines IgA tTG and IgG DGP, and reduces the number of tests currently used in celiac screening. However, intestinal biopsy is always required to confirm the presence of celiac disease no matter what serological tests are involved.
    Source:
    http://www.ncbi.nlm.nih.gov/pubmed/20136587


    Jefferson Adams
    Celiac.com 03/25/2010 - A team of researchers recently set out to compare the diagnostic performance of IgG anti-deamidated gliadin peptide antibody assays against IgA anti-tTG in celiac disease. The team included P. Vermeersch, K. Geboes, G. Mariën, I. Hoffman, M. Hiele, X. Bossuyt, all associated with the department of Laboratory Medicine, Immunology of University Hospitals at the Catholic University of Leuven, Belgium.
    Using IgG anti-deamidated gliadin peptide antibody assays to test for celiac disease is more sensitive and more specific for celiac disease than detection of IgG antibodies against native gliadin. The team compared assessed the technical performance and accuracy (sensitivity and specificity) of commercial IgG anti-DGP assays from Euroimmun, Inova, Phadia and The Binding Site against other serologic assays for celiac disease, such as 3IgA and 2IgG anti-tTG assays, 1IgA and 1IgG anti-gliadin assay, 1IgA anti-DGP assay.
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    The four IgG anti-DGP assays all performed within acceptable limits, and diagnosed celiac disease with comparable accuracy as did the three IgA anti-tTG assays.
    Source:

    Clin Chim Acta. 2010 Feb 19.

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/23/2018 - If you’re looking for a great gluten-free Mexican-style favorite that is sure to be a big hit at dinner or at your next potluck, try these green chili enchiladas with roasted cauliflower. The recipe calls for chicken, but they are just as delicious when made vegetarian using just the roasted cauliflower. Either way, these enchiladas will disappear fast. Roasted cauliflower gives these green chili chicken enchiladas a deep, smokey flavor that diners are sure to love.
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    Jefferson Adams
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    Bakery On Main started in the small bakery of a natural foods market on Main Street in Glastonbury, Connecticut. Founder Michael Smulders listened when his customers with Celiac Disease would mention the lack of good tasting, gluten-free options available to them. Upon learning this, he believed that nobody should have to suffer due to any kind of food allergy or dietary need. From then on, his mission became creating delicious and fearlessly unique gluten-free products that were clean and great tasting, while still being safe for his Celiac customers!
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    Jefferson Adams
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    Source:
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