D1 biopsy helps spot ultra-short celiac disease

Last Updated: 2016-02-17

By David Douglas

NEW YORK (Reuters Health) - Additional biopsy collection from any site in the duodenal bulb (D1) increases conventional celiac disease diagnosis yield and aids detection of ultra-short celiac disease (USCD), according to U.K. and U.S. researchers.

In a paper online January 30 in Gastroenterology, Dr. Peter D. Mooney of Royal Hallamshire Hospital, Sheffield, and colleagues note that celiac disease is underdiagnosed in general and D1 may be the only site of villous atrophy in newly diagnosed celiac disease. However, this approach is not yet fully accepted for reasons including very limited experience.

To investigate further, the team prospectively studied more than 1,300 patients who underwent endoscopy. Routine duodenal biopsies were collected from D1 and the second part of duodenum (D2).

In all, 268 patients (19.4%) were diagnosed with celiac disease and 171 underwent quadrantic D1 biopsy. Of these, 65 patients (38%) were diagnosed with celiac disease.

Twenty-six patients had villous atrophy confined to D1 and were diagnosed with USCD. Of these, seven had entirely normal D2 biopsies. Collection of a single additional biopsy from any D1 site, say the investigators, increased the sensitivity of celiac disease detection by about 10%.

Patients with USCD were significantly younger, had lower titers of tissue transglutaminase antibody, and less frequently presented with diarrhea. The conventional celiac disease group were significantly more likely to have ferritin or folate deficiency than the USCD group or controls.

All patients diagnosed with USCD and conventional celiac disease received specialist dietetic advice. After a median of about 15.5 months, there was no significant difference between the median symptom improvement scores between USCD and conventional celiac disease patients on a gluten free diet.

The researchers speculate that, "Perhaps USCD represents the next step in the development of a more extensive enteropathy. Further study may identify which patients require long term follow up for now however USCD and conventional celiac disease patients should be treated as part of the spectrum of the same disease and receive standard follow up."

Commenting on the findings by email, Dr. Carolina Sousa of the University of Seville, Spain, told Reuters Health, "Patients with USCD would be prone to lack of a correct diagnosis due to concentration of findings just at the D1 portion of duodenum."

Dr. Sousa, who has conducted research in the field, added that "the authors provide evidence of potential endoscopy bias and note that its reduction could eliminate misdiagnosis. Specimens from the proximal duodenum are encouraged."

Dr. Mooney did not respond to requests for comments.

SOURCE: bit.ly/1TnGhX5

Gastroenterology 2016.