Document Detail

Variability of histologic lesions in relation to biopsy site in gluten-sensitive enteropathy.
MedLine Citation:
PMID:  15654798     Owner:  NLM     Status:  MEDLINE    
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.
Alberto Ravelli; Stefania Bolognini; Marco Gambarotti; Vincenzo Villanacci
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  100     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-01-18     Completed Date:  2005-02-15     Revised Date:  2010-10-15    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  177-85     Citation Subset:  IM    
Gastrointestinal Pathophysiology, University Department of Pediatrics, Children's Hospital, Spedali Civili, 25123 Brescia, Italy.
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MeSH Terms
Atrophy / pathology
Biopsy, Needle
Celiac Disease / blood,  pathology*
Child, Preschool
Duodenum / pathology*
HLA-DQ Antigens / blood
Lymphocyte Count
Prospective Studies
Reg. No./Substance:
0/HLA-DQ Antigens; 0/HLA-DQA1; 0/HLA-DQB1 antigen
Comment In:
Am J Gastroenterol. 2005 Sep;100(9):2128; author reply 2128-30   [PMID:  16128960 ]

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