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Research Highlights Importance of Biopsy Site for Diagnosing Celiac Disease in Children

Photograph of a female medical technician wearing a hair net and surgical face mask, standing in front of a microscope, and looking at a microscope slide held in her right hand.

Intestinal biopsy—examination of tissue from the small intestine—is considered the gold standard for diagnosing celiac disease. Recent research suggests that selection of the biopsy site may influence the accuracy of diagnosis in children.

The American Gastroenterological Association’s guidelines for biopsy include a recommendation for obtaining multiple specimens “from the second part of the duodenum or beyond.” The duodenum, which is roughly 10 inches long in adults, is the section of the small intestine that joins the stomach. Obtaining samples from numerous sites reduces the likelihood of missing celiac disease damage, which typically occurs in patches.

Researchers from the faculty of medicine at Dalhousie University in Halifax, Nova Scotia, Canada, published findings from a study suggesting that biopsy sample sites should include the duodenal bulb—the section of the duodenum immediately adjacent to the stomach. Over 2 years, Mohsin Rashid, M.D., associate professor of pediatrics, and medical student Andrea MacDonald examined biopsy samples obtained from the duodenal bulb and from sites in the second or more distal—farther along—sections of the duodenum in 35 celiac disease patients ranging in age from 17 months to 18 years. Thirty-one of these children had abnormal distal biopsies and all but two also had abnormal bulb biopsies. More significantly, four children with normal distal biopsies showed effects of celiac disease in bulb biopsies.

“Diagnosis of celiac disease would not have been possible in these four cases with distal duodenal biopsies only,” Rashid wrote in an article that appeared in BMC Gastroenterology. “The optimal strategy for detecting villous changes should include biopsies not only from the distal duodenum but also from the bulb to improve the diagnostic yield,” he concluded.

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Page last updated September 24, 2014


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