Effectiveness of duodenal bulb biopsies in histological diagnosis of coeliac disease.

IF 3 3区医学 Q1 PEDIATRICS

European Journal of Pediatrics Pub Date : 2025-04-02 DOI:10.1007/s00431-025-06113-9

M Ahmed, T Tolufase, P Gill, M I Sayed

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引用次数: 0

Abstract

Coeliac disease is an autoimmune condition with variable presentation which leads to difficulties and delays in diagnosis. A retrospective study was undertaken to investigate the effectiveness of duodenal bulb biopsies in histologic diagnosis of coeliac disease. Histology specimens were analysed from 230 patients, age ranging from 0 to 16 years over a 10-year period (2014-2024) who had raised tissue transglutaminase/endomysial antibodies and were referred for an upper gastrointestinal endoscopy to confirm/rule out coeliac disease. Biopsies taken from the proximal (D1) and distal duodenum (D2, 3, 4) were compared in 145 children who were confirmed to have the diagnosis of coeliac disease on histopathology. The results revealed that a significant number of children (56/145; 38.6%) had positive histological changes seen in proximal duodenum only with completely normal histology in distal duodenum. In comparison, only 4/145 (2.8%) children yielded positive histology result from distal duodenum with normal proximal duodenal biopsies. Proximal duodenal segment histology samples therefore had the highest sensitivity (97%), negative predictive value (95.5%), and accuracy (98%).

Conclusion: Our fundings re-enforce the importance of obtaining an adequate number of proximal duodenal samples for histological analysis in children investigated for coeliac disease in order to avoid delayed or missed diagnosis in this age group.

What is known: • Coeliac disease affects 1-2% of western population though prevalence varies by the region. • A sub-set of suspected cases with anti-tissue transglutaminase (TTG) antibody titres of less than ten times the upper limit of normal require duodenal biopsies for confirmation of diagnosis.

What is new: • Duodenal bulb biopsies have higher sensitivity and negative predictive value when compared to distal duodenal biopsies. • Endoscopist must obtain adequate number of samples from proximal duodenum (duodenal bulb) to avoid false negative results.

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十二指肠球部活检在乳糜泻组织学诊断中的价值。

乳糜泻是一种自身免疫性疾病，具有多种表现形式，导致诊断困难和延误。回顾性研究十二指肠球部活检在乳糜泻的组织学诊断中的有效性。对230例患者的组织学标本进行分析，这些患者的年龄在10年（2014-2024年）期间从0岁到16岁不等，他们的组织转谷氨酰胺酶/肌内膜抗体升高，并被转介进行上消化道内窥镜检查以确认/排除乳糜泻。对145例经组织病理学确诊为乳糜泻的患儿进行近端十二指肠（D1）和远端十二指肠（D2、3、4）活检。结果显示，大量儿童(56/145；38.6%)仅近端十二指肠组织学改变阳性，远端十二指肠组织学完全正常。相比之下，只有4/145（2.8%）患儿远端十二指肠活检结果阳性，近端十二指肠活检正常。因此，近端十二指肠段组织学标本具有最高的敏感性（97%）、阴性预测值（95.5%）和准确性（98%）。结论：我们的研究再次强调了在调查乳糜泻的儿童中获得足够数量的近端十二指肠样本进行组织学分析的重要性，以避免该年龄组的延误或漏诊。已知情况：•乳糜泻影响西方1-2%的人口，但患病率因地区而异。•抗组织转谷氨酰胺酶（TTG）抗体滴度低于正常上限十倍的疑似病例需要十二指肠活检以确认诊断。新发现：•与远端十二指肠活检相比，十二指肠球部活检具有更高的敏感性和阴性预测值。内镜医师必须从近端十二指肠（十二指肠球）获取足够数量的样本，以避免假阴性结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pediatrics 医学-小儿科

CiteScore

5.90

自引率

2.80%

发文量

367

审稿时长

3-6 weeks

期刊介绍： The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics. EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned. The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics. EJPE is active on social media (@EurJPediatrics) and we invite you to participate. EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.