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    Jefferson Adams

    Variability of Histopathological Changes in Childhood Celiac Disease

    Jefferson Adams
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    Reviewed and edited by a celiac disease expert.

    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.



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    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.

    They looked at a total of 198 consecutive cases of celiac disease diagnosed at the Children’ s Hospital from 2001 to 2005. The team scored all biopsies using the Marsh criteria applied by a pathologist blinded to the clinical data.

    The researchers categorized mucosal changes as 'focal' if changes consistent with celiac disease and normal mucosa were found within a single biopsy fragment. They defined 'patchiness' as variation of at least one Marsh grade between separate fragments in a biopsy set. The median patient age was 9.3 years; 62% were female.

    The researchers took more than 700 biopsy samples, an average of 3.6 per patient. In 101 cases, they took biopsy sample from both the duodenal bulb and the second portion of the duodenum.

    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.

    The research team concluded that duodenal involvement in childhood celiac disease is often patchy and may show variable severity even within a single biopsy fragment not reliably predicted by clinical characteristics. To maximize diagnostic yield, they recommend taking multiple endoscopic biopsies, including the duodenal bulb, in suspected cases of pediatric celiac disease.

    Source:
    Am J Gastroenterol  6 October 2009; doi: 10.1038/ajg.2009.557

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    My son is a celiac disease patient, according to this report anti tissue transglutaminase IGA result(s )units 174.5 u/ml and reference range is 0-10. I don't know that it is positive or not.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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