Diagnostic Duodenal Bulb Biopsy in Celiac Disease

BACKGROUND AND STUDY AIMS: Duodenal or jejunal biopsies are needed to establish the diagnosis of celiac disease. It is widely advocated that these biopsies be taken from the distal duodenum. PATIENTS AND METHODS: After finding two index cases with diagnostic biopsies taken from the duodenal bulb, we retrospectively analyzed biopsies from the descending duodenum and the duodenal bulb of 51 patients with suspected or diagnosed celiac disease. The diagnosis of celiac disease and classification of the histological changes were performed by one pathologist. RESULTS: In the two index cases the diagnosis of celiac disease could only be established by taking the biopsies from the duodenal bulb, and not from the descending duodenum. In the retrospective analysis the number of intraepithelial lymphocytes was on average higher, but not significantly, in the descending part of the duodenum. CONCLUSIONS: Most patients with celiac disease show similar mucosal changes in biopsies taken from the descending part of the duodenum and from the duodenal bulb. But in patients who have already been on a gluten-free diet in childhood and later abandoned their diet, an additional duodenal bulb biopsy should be done.