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Duodenal Bulb is Shown to be the Best Place to Find Villous Atrophy
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.
Jejunal 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."
- 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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Diagnostic Performance of IgG Anti-deamidated Gliadin Peptide Antibody Assays is Comparable to IgA Anti-tTG in Celiac Disease
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.... [READ MORE]
Is DGP Serological Test the Wave of the Future for Celiac Disease Testing?
Many people are confused about which tests provide the most accurate results for a celiac disease diagnosis.... [READ MORE]
Variability of Histopathological Changes in Childhood Celiac Disease
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.... [READ MORE]
Commercial Tissue Transglutaminase (tTG) Lab Screenings May Miss Many Cases of Celiac Disease
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.... [READ MORE]
Diana Gitig Ph.D.
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.Â 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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