Department of Superspeciality of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, UT, 160 012, India.
World J Pediatr. 2010 Feb;6(1):60-4. doi: 10.1007/s12519-010-0008-3. Epub 2010 Feb 9.
Celiac disease (CD) may cause changes throughout the gastrointestinal tract. Patchy distribution of duodenal mucosal lesions has been described in adults as well as in children. This study aimed to verify the concept and to evaluate the frequency of histologic lesion variability of the duodenal mucosa in Indian children with CD.
We enrolled 67 children prospectively who underwent upper gastrointestinal endoscopy because of positive tissue transglutaminase antibodies and biopsy as the final evaluation for suspected CD. Four biopsies were taken from the descending duodenum distal to the papilla, and duodenal bulb. The histologic lesions were classified according to the Oberhuber classification with modification proposed by our group.
Forty-three CD children (64.2%) had a "mixed" type 3 lesion characterized by a different degree of villous atrophy at different biopsy sites. Eight children (11.9%) showed two different types of histologic lesions in the same patient at different biopsy sites. The overall variability of histologic lesion (variability in the grade of villous atrophy [type 3a, 3b, or 3c], and coexistence of villous atrophy and type 2 lesion) was seen in 51 (76.1%) of the CD patients.
Children with CD show a high frequency of variability of histologic lesions. Therefore, multiple endoscopic biopsy specimens should be obtained not only from the distal duodenum but also from the bulb.
乳糜泻（CD）可能导致整个胃肠道发生变化。在成人和儿童中均已描述过十二指肠黏膜病变呈斑片状分布。本研究旨在验证这一概念，并评估印度 CD 患儿十二指肠黏膜组织学病变变异性的频率。
我们前瞻性地招募了 67 名因组织转谷氨酰胺酶抗体阳性和活检而接受上消化道内镜检查的儿童，作为疑似 CD 的最终评估。从乳头远端的降段和十二指肠球部采集 4 个活检标本。根据 Oberhuber 分类和我们小组提出的改良分类对组织学病变进行分类。
43 名 CD 患儿（64.2%）存在“混合”型 3 病变，其特征是在不同活检部位存在不同程度的绒毛萎缩。8 名患儿（11.9%）在同一患者的不同活检部位显示出两种不同类型的组织学病变。51 名（76.1%）CD 患儿存在组织学病变变异性（绒毛萎缩程度的变异性[3a、3b 或 3c 型]和绒毛萎缩与 2 型病变共存）。
CD 患儿的组织学病变变异性发生率较高。因此，不仅应从远端十二指肠，还应从球部获取多个内镜活检标本。
