ArticleThe American journal of gastroenterology2016
A Prospective Study on the Usefulness of Duodenal Bulb Biopsies in Celiac Disease Diagnosis in Children: Urging Caution.
Article in The American journal of gastroenterology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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27 citing papers in PubMed, 53 citations in OpenAlex.
- The frequency and characteristics of ultra-short celiac disease in children: A single-center experience.European journal of pediatrics · 2026Article
- Ultra-short celiac disease in children: histological and autoimmune features.European journal of pediatrics · 2026Article
- Bulb biopsies for diagnosing celiac disease in children: A prospective multicenter study using quantitative histomorphometry.Journal of pediatric gastroenterology and nutrition · 2026Observational
- Low positive and borderline negative transglutaminase antibody levels are frequently associated with a coeliac disease diagnosis.Journal of internal medicine · 2025Article
- Classification of Paediatric Celiac Disease Using RNA Sequencing and Real-Time PCR of Duodenal Biomarkers.Journal of cellular and molecular medicine · 2025Article
- Frequency of Celiac Disease in Irritable Bowel Syndrome: Insights From a Tertiary Care Hospital.Cureus · 2025Article
- Diagnostic Challenges in Enteropathies: A Histopathological Review.Diagnostics (Basel, Switzerland) · 2025Review
- Villous atrophy in celiac disease: striking differences in endoscopic findings between the duodenal bulb and descending duodenum.Clinical journal of gastroenterology · 2025Article
- Intestinal celiac disease - related autoantibodies.Frontiers in immunology · 2025Review
- Refractory Celiac Disease: What the Gastroenterologist Should Know.International journal of molecular sciences · 2024Review
- Budesonide Induces Favourable Histologic and Symptomatic Recovery in Patients with Non-responsive and Refractory Coeliac Disease When Given in an Open Capsule Format.Digestive diseases and sciences · 2024Article
- Computer-Based Diagnosis of Celiac Disease by Quantitative Processing of Duodenal Endoscopy Images.Diagnostics (Basel, Switzerland) · 2023Article
- Review on pediatric coeliac disease from a clinical perspective.European journal of pediatrics · 2022Review
- Celiac Disease Revisited.GE Portuguese journal of gastroenterology · 2022Review
- Review
- Duodenal Bulb Histology in Paediatric Celiac Disease: A Case-Control Study.Journal of the Canadian Association of Gastroenterology · 2020Article
- Diagnostic accuracy and applicability of intestinal auto-antibodies in the wide clinical spectrum of coeliac disease.EBioMedicine · 2020Article
- Narrow band imaging evaluation of duodenal villi in patients with and without celiac disease: A prospective study.World journal of gastrointestinal endoscopy · 2019Article
- Diagnosing Celiac Disease: Towards Wide-Scale Screening and Serology-Based Criteria?Gastroenterology research and practice · 2019Review
- Diagnosis of Celiac Disease: Taking a Bite Out of the Controversy.Digestive diseases and sciences · 2018Review
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Authors and funding
13 authors at 8 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesSeveral recent celiac disease guidelines recommend the acquisition of duodenal bulb biopsies for diagnostics. This is in conflict with previously reported evidence and routine practice from the 1960s onward. We reopened the issue in a prospective multicenter study and used morphometric variables in evaluating the usefulness of bulb biopsies in children. We further sought to establish whether deposits of IgA targeting bulb transglutaminase 2 (TG2) could be of diagnostic help.
methodsDiagnoses of celiac disease were based on clinic and distal duodenal histopathology statements. Centralized reading of villous height (VH) to crypt depth (CrD) ratios and IgA deposits was performed on anatomical duodenal bulb specimens. All children participating also underwent routine investigations for other diseases.
resultsTwenty-two children had celiac disease, and another 22 served as non-celiac disease controls. The quality of the anatomical bulb specimens was unsatisfactory for reliable morphometric measurements in 20 out of 44 (45%) patients even after recuttings. All celiac disease patients had VH:CrD<2.0 (mean 0.2) but also 10 out of 13 (77%) non-celiac control patients had an injured bulb mucosal lining (mean 1.3) even up to false-positive "flat lesion". Bulb IgA deposits were able to separate celiac disease from disease controls.
conclusionsMorphological injury is common in the anatomical bulb even without celiac disease, increasing the risk of false-positive diagnoses. Premature conclusions might have been drawn on current care guidelines as to celiac disease diagnosis based solely on anatomical bulb specimens. Bulb mucosal IgA targeting TG2 in poor quality biopsy specimens is a powerful clinical tool in finding celiac disease patients.
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