Department of Gastroenterology, Sheffield Teaching Hospitals Trust, UK.
Am J Gastroenterol. 2011 Oct;106(10):1837-742. doi: 10.1038/ajg.2011.171. Epub 2011 May 24.
Recent reports suggest that the duodenal bulb may be the only site to demonstrate villous atrophy (VA) in celiac disease. However, there is a paucity of data from newly diagnosed adult celiac patients and no data from those patients with established celiac disease. The objective of this study was to compare the histological findings in the duodenal bulb and distal duodenum of patients with adult celiac disease (newly diagnosed or established) against controls.
A total of 461 patients were prospectively recruited. Biopsies were graded using the Marsh criteria.
In all, 461 patients (300 females and 161 males) with median age 51 years were analyzed. In all, 126 had newly diagnosed celiac disease, 85 established celiac disease, and 250 controls. New diagnosis celiac disease (9%, P<0.0001) and established celiac disease (14%, P<0.0001) were more likely than controls to have VA in the bulb alone. Overall, when comparing the histological lesion of the bulb against the distal duodenum, 31/85 with established celiac disease (P<0.0001) and 21/126 newly diagnosed (P=0.0067) had a discrepancy in the severity of the lesion between the two sites compared with 18/250 controls. In all, 24/31 with established celiac disease and 16/21 newly diagnosed had the more severe lesion in the bulb.
VA may be present only in the duodenal bulb. This study suggests that the optimal assessment of patients in whom celiac disease is suspected (with positive serology) and those with established celiac disease requires a duodenal bulb biopsy in addition to distal duodenal biopsies.
最近的报告表明，十二指肠球部可能是乳糜泻中唯一出现绒毛萎缩（VA）的部位。然而，新诊断的成人乳糜泻患者的数据很少，也没有来自已确诊乳糜泻患者的数据。本研究的目的是比较新诊断或已确诊的成人乳糜泻患者（新诊断或已确诊）和对照组的十二指肠球部和远段十二指肠的组织学发现。
共前瞻性招募了 461 例患者。使用 Marsh 标准对活检进行分级。
共分析了 461 例患者（300 名女性和 161 名男性），中位年龄为 51 岁。共有 126 例新诊断的乳糜泻，85 例已确诊的乳糜泻和 250 例对照组。新诊断的乳糜泻（9%，P<0.0001）和已确诊的乳糜泻（14%，P<0.0001）比对照组更有可能仅在球部出现 VA。总体而言，当比较球部和远段十二指肠的组织学病变时，与对照组相比，31/85 例已确诊的乳糜泻（P<0.0001）和 21/126 例新诊断的乳糜泻（P=0.0067）在两个部位的病变严重程度存在差异。共有 24/31 例已确诊的乳糜泻和 16/21 例新诊断的乳糜泻的病变更严重。
VA 可能仅存在于十二指肠球部。本研究表明，对于疑似乳糜泻（血清学阳性）的患者和已确诊的乳糜泻患者，除了远段十二指肠活检外，还需要进行十二指肠球部活检。
