The Characteristics of Isolated Duodenal Bulb Coeliac Disease in Children: A Multicentre Retrospective Study.

Aim: A minority of patients with coeliac disease have mucosal pathology limited to the duodenal bulb. We aimed to describe the baseline characteristics of isolated duodenal bulb coeliac disease in children.

Methods: In this retrospective multicentre study of paediatric patients diagnosed with coeliac disease, based on biopsies obtained separately from the duodenal bulb and distal duodenum, we evaluated the demographic, anthropometric, clinical, associated diseases and coeliac serology characteristics of the patients.

Results: Among the 586 children diagnosed with coeliac disease, 459 (78%) were classified as classic and 127 (22%) as isolated duodenal bulb coeliac disease-376 (64.2%) were female and the median age was 7 years (IQR 5-11). In multivariate logistic regression, scalloping of the duodenum (55.1% vs. 17.3%, p < 0.001, OR 4.7, 95% CI 2.8-8), growth impairment (9.8% vs. 9.4%, p = 0.012, OR 2.7, 95% CI 1.4-5.5) and baseline anti-tissue transglutaminase levels > 10 upper limit of norm (71.5% vs. 29.9%, p < 0.001, OR 4.5, 95% CI 2.8-7.2) were associated with a higher probability of having classic coeliac disease.

Conclusions: Lack of growth impairment, anti-tissue transglutaminase levels > 10 upper limit of norm and duodenal scalloping are predictive of isolated duodenal bulb involvement, making duodenal bulb biopsies even more important during esophagogastroduodenoscopy for the diagnosis of coeliac disease.