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This study suggests biopsies can yield reliable results, irrespective of
the sampling site location within the duodenum or jejunum, in subjects who
present positive for HLA-DQ2 or DQ8 and have positive serology for celiac
disease.

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Am J Gastroenterol. 2005 Jan;100(1):177-85

Variability of histologic lesions in relation to biopsy site in gluten-
sensitive enteropathy.

Ravelli A, Bolognini S, Gambarotti M, Villanacci V.

Gastrointestinal Pathophysiology, University Department of Pediatrics,
Children's Hospital, Spedali Civili, Brescia, Italy.

OBJECTIVES: It is generally believed that in gluten-sensitive enteropathy
or celiac disease (CD), mucosal lesions may have a patchy distribution. We
wanted to verify this concept and establish whether one or more biopsy
samples are needed in order to make a correct diagnosis of CD. METHODS: One
hundred and twelve consecutive children with positive antiendomysium (EMA)
or antitissue transglutaminase (tTGA) antibodies, referred to us for
suspected CD, were enrolled in a prospective fashion. During upper GI
endoscopy four to five biopsies were taken from Treitz and/or distal
duodenum (D3), intermediate duodenum (D2), proximal duodenum (D1), and
duodenal bulb (B). Histologic lesions were classified according to Marsh
criteria modified by Oberhuber. RESULTS: A total of 110 patients, all HLA-
DQ2 or DQ8 positive, had a final diagnosis of CD (59 classic, 28 atypical,
and 23 silent): 102/110 (92.7%) had type 3 lesion-(a) mild, (b) moderate,
or (c) severe-in at least one site and 94/110 (85.4%) had villous atrophy
(VA) of some degree in all sites. VA of identical degree was present in all
biopsy sites in 55/110 (50%) patients. Total VA (type 3c) was present in at
least one site in 85/110 (75%), in all sites in 50/110 (45.4%), and
significantly increased in aborad direction ((chi(2) > 26.22 with (= 0.01
and d.f. (degrees of freedom) = 12). Eight out of 110 (7.2%) CD patients
had exclusively type 1 or 2 lesions, no patient had lesion variability >1
degree and none had normal biopsies. There was no correlation between type
or distribution of histologic lesions and clinical presentation of CD.
CONCLUSIONS: Mucosal atrophy is present in 85% of patients with CD and
total VA is significantly more frequent in distal duodenum or proximal
jejunum. Fifty percent of patients have identical VA throughout the
duodenum and no duodenal areas are histologically normal. In genetically
susceptible children with positive serology, a diagnosis of CD can reliably
be made even if biopsies are not taken from the distal duodenum or jejunum.
(Am J Gastroenterol 2005;100:177-185).

PMID: 15654798 [PubMed - in process]

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