Duodenal Bulb Biopsies in Celiac Disease: A Multicenter Study

ABSTRACT Objectives: Celiac disease (CD)–related lesions have been reported in duodenal bulb biopsies, sometimes the bulb mucosa being the only one affected. The aim was to verify in a significant series whether histological lesions are always present in the bulb of celiac patients, what is the prevalence of lesions when isolated to the bulb, and if similar lesions are present in nonceliac subjects. Methods: We studied 665 children with CD (241 males, range 9 months–15 years, 8 months), at diagnosis on a gluten‐containing diet, and 348 age‐ and sex‐matched gastroenterological controls submitted to upper endoscopy for gastroenterological complaints. During endoscopy, multiple biopsies (1 bulb and 4 distal duodenum samples) were taken. Anti‐endomysium antibodies were evaluated by immunofluorescence method, anti–human tissue–transglutaminase antibodies by an enzyme‐linked immunosorbent assay or radioimmunoassay. Human leukocyte antigen‐DRB1, ‐DQA1, and ‐DQB1 genes were typed by polymerase chain reaction sequence–specific primers repeat method. Results: In all of the patients with CD, histological lesions were present in the bulb sample; in 16 of them, the lesions were present only in the bulb. Patchy villous atrophy was found in 20 children. All of the patients with CD were anti‐endomysium and/or anti‐transglutaminase positive. The controls showed neither autoantibody positivity nor mucosal changes compatible with CD. Conclusions: This study demonstrated that CD‐related histological lesions are always present in the bulb; sometimes this specific site is the only one affected. Therefore, we suggest taking 2 biopsies from the bulb and 2 from the distal duodenum for CD diagnosis.