Diagnostic utility of multiple site duodenal biopsies in celiac disease

Background: Celiac Disease involves the small intestine patchily affecting more frequently the proximal small bowel but the histological changes have been observed till terminal ileum. Of late in addition to D2, the duodenal bulb (D1 region) biopsies have been found helpful in identifying a small gr...

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Autores principales:	Vikarm Narang, Akriti Jindal, Aminder Singh, Bhavna Garg Varun Mehta, Neena Sood, Ajit Sood
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer Medknow Publications 2021
Materias:	celiac disease diagnosis duodenum multiple biopsies tissue transglutaminase Pathology RB1-214 Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/5b1cdafc3a834ac78761c22aa2231cad
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spelling	oai:doaj.org-article:5b1cdafc3a834ac78761c22aa2231cad2021-12-02T17:49:10ZDiagnostic utility of multiple site duodenal biopsies in celiac disease0377-492910.4103/IJPM.IJPM_797_20https://doaj.org/article/5b1cdafc3a834ac78761c22aa2231cad2021-01-01T00:00:00Zhttp://www.ijpmonline.org/article.asp?issn=0377-4929;year=2021;volume=64;issue=5;spage=73;epage=77;aulast=Naranghttps://doaj.org/toc/0377-4929Background: Celiac Disease involves the small intestine patchily affecting more frequently the proximal small bowel but the histological changes have been observed till terminal ileum. Of late in addition to D2, the duodenal bulb (D1 region) biopsies have been found helpful in identifying a small group of patients with CD. Therefore, multiple site biopsies are recommended as histological changes are not uniform throughout small intestine. Methods: During this present 1.5 years prospective study, we evaluated 84 cases of suspected celiac disease with respect to the light microscopy (D1, D2, and D3 biopsy) and serology (anti tTg and or EMA). Histological examination was done according to Modified Marsh grading system. Results: Out of 84 cases with raised anti tTg, the segmental biopsies significantly increased the diagnostic accuracy from 39/44 cases (88.6%) to 43/44 cases (97.7%) and 44/44 cases (100%) when D2 alone, D1 + D2 and D1 + D2 + D3 biopsies were evaluated, respectively. Of the suspected cases of celiac disease patients (tTg > 10 ULN and associated weight loss, diarrhea), additional D3 biopsy increased the diagnostic yield by 2.1%, compared to D1, D2 region biopsy and 6.38% compared to standard D2 biopsy alone. Of the 28 cases (tTg > 10 times ULN + EMA positive and associated weight loss, diarrhea), the potential celiac disease (histologically Type 1/Normal) cases reduced from 28.5% (standard D2 region alone) to 21.4% and 17.8% when additional biopsies were taken from D1 region and D3 region, respectively, and additional D3 biopsy increased the diagnostic yield by 10.8% (compared to standard D2 biopsy alone) and 3.7% (compared to D1 and D2 biopsy). Conclusion: We believe multiple sites duodenal biopsies including D3 region biopsies might increase the diagnostic accuracy of adult celiac disease in addition to sensitive and specific serologic tests.Vikarm NarangAkriti JindalAminder SinghBhavna Garg Varun MehtaNeena SoodAjit SoodWolters Kluwer Medknow Publicationsarticleceliac diseasediagnosisduodenummultiple biopsiestissue transglutaminasePathologyRB1-214MicrobiologyQR1-502ENIndian Journal of Pathology and Microbiology, Vol 64, Iss 5, Pp 73-77 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	celiac disease diagnosis duodenum multiple biopsies tissue transglutaminase Pathology RB1-214 Microbiology QR1-502
spellingShingle	celiac disease diagnosis duodenum multiple biopsies tissue transglutaminase Pathology RB1-214 Microbiology QR1-502 Vikarm Narang Akriti Jindal Aminder Singh Bhavna Garg Varun Mehta Neena Sood Ajit Sood Diagnostic utility of multiple site duodenal biopsies in celiac disease
description	Background: Celiac Disease involves the small intestine patchily affecting more frequently the proximal small bowel but the histological changes have been observed till terminal ileum. Of late in addition to D2, the duodenal bulb (D1 region) biopsies have been found helpful in identifying a small group of patients with CD. Therefore, multiple site biopsies are recommended as histological changes are not uniform throughout small intestine. Methods: During this present 1.5 years prospective study, we evaluated 84 cases of suspected celiac disease with respect to the light microscopy (D1, D2, and D3 biopsy) and serology (anti tTg and or EMA). Histological examination was done according to Modified Marsh grading system. Results: Out of 84 cases with raised anti tTg, the segmental biopsies significantly increased the diagnostic accuracy from 39/44 cases (88.6%) to 43/44 cases (97.7%) and 44/44 cases (100%) when D2 alone, D1 + D2 and D1 + D2 + D3 biopsies were evaluated, respectively. Of the suspected cases of celiac disease patients (tTg > 10 ULN and associated weight loss, diarrhea), additional D3 biopsy increased the diagnostic yield by 2.1%, compared to D1, D2 region biopsy and 6.38% compared to standard D2 biopsy alone. Of the 28 cases (tTg > 10 times ULN + EMA positive and associated weight loss, diarrhea), the potential celiac disease (histologically Type 1/Normal) cases reduced from 28.5% (standard D2 region alone) to 21.4% and 17.8% when additional biopsies were taken from D1 region and D3 region, respectively, and additional D3 biopsy increased the diagnostic yield by 10.8% (compared to standard D2 biopsy alone) and 3.7% (compared to D1 and D2 biopsy). Conclusion: We believe multiple sites duodenal biopsies including D3 region biopsies might increase the diagnostic accuracy of adult celiac disease in addition to sensitive and specific serologic tests.
format	article
author	Vikarm Narang Akriti Jindal Aminder Singh Bhavna Garg Varun Mehta Neena Sood Ajit Sood
author_facet	Vikarm Narang Akriti Jindal Aminder Singh Bhavna Garg Varun Mehta Neena Sood Ajit Sood
author_sort	Vikarm Narang
title	Diagnostic utility of multiple site duodenal biopsies in celiac disease
title_short	Diagnostic utility of multiple site duodenal biopsies in celiac disease
title_full	Diagnostic utility of multiple site duodenal biopsies in celiac disease
title_fullStr	Diagnostic utility of multiple site duodenal biopsies in celiac disease
title_full_unstemmed	Diagnostic utility of multiple site duodenal biopsies in celiac disease
title_sort	diagnostic utility of multiple site duodenal biopsies in celiac disease
publisher	Wolters Kluwer Medknow Publications
publishDate	2021
url	https://doaj.org/article/5b1cdafc3a834ac78761c22aa2231cad
work_keys_str_mv	AT vikarmnarang diagnosticutilityofmultiplesiteduodenalbiopsiesinceliacdisease AT akritijindal diagnosticutilityofmultiplesiteduodenalbiopsiesinceliacdisease AT amindersingh diagnosticutilityofmultiplesiteduodenalbiopsiesinceliacdisease AT bhavnagargvarunmehta diagnosticutilityofmultiplesiteduodenalbiopsiesinceliacdisease AT neenasood diagnosticutilityofmultiplesiteduodenalbiopsiesinceliacdisease AT ajitsood diagnosticutilityofmultiplesiteduodenalbiopsiesinceliacdisease
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Diagnostic utility of multiple site duodenal biopsies in celiac disease

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