Sampling of proximal and distal duodenal biopsies in the diagnosis and monitoring of celiac disease

Abstract

Background: Since celiac disease-associated mucosal lesions are patchy, the diagnosis of the disease requires histological evaluation of multiple duodenal biopsies.

Aim: To examine whether adequate biopsy sampling in either the bulb or distal duodenum is sufficient to diagnose celiac disease.

Methods: Twenty-five patients with positive celiac disease-specific serology and 17 patients with negative serology, who were on a gluten-containing diet, and 13 celiac disease patients on a gluten-free diet were consecutively and prospectively enrolled. Mucosal damage, anti-transglutaminase-2 IgA deposits, interferon-γ, interleukin-17A and interleukin-15 transcripts were evaluated in bulb and distal duodenal biopsies.

Results: All patients with positive celiac disease-specific serology exhibited villous atrophy in both duodenal sites. In this group, mucosal anti-transglutaminase-2 IgA deposits were found in 24/25 (96%) bulb samples and 22/25 (88%) distal duodenal samples. No villous atrophy was documented in patients with negative serology. Interferon-γ and interleukin-17A were over-expressed in both duodenal sites of patients with villous atrophy, unlike patients with normal duodenal morphology (p<0.001). Among treated celiac disease patients, 2 (15.4%) had villous atrophy exclusively in the bulb and 6 (46.2%) had minimal histological abnormalities at both sites.

Conclusion: Sampling in the bulb and distal duodenum could be sufficient to diagnose/exclude celiac disease.

Keywords: Anti-transglutaminase-2; Celiac disease; Duodenum; Interferon-gamma.