Department of Paediatrics, Sapienza University of Rome, Rome, Italy.
J Clin Gastroenterol. 2012 Apr;46(4):302-7. doi: 10.1097/MCG.0b013e31822d31da.
Celiac disease (CD)-related lesions were described in duodenal bulb of celiac patients.
Our aim was to evaluate the morphology of bulb mucosa in adult celiac patients and in controls to evaluate its usefulness for CD diagnosis.
We studied 43 celiac patients (10 male, median age: 35.2 y) at diagnosis and 43 gastroenterological controls (10 male, median age: 37.8 y), submitted to upper endoscopy for gastroenterological complaints. Histologic lesions were assayed by an experienced pathologist according to the Marsh modified classification. Antiendomysium antibodies and antitransglutaminase antibodies-tTGAb (ELISA and/or RIA) have been tested. In selected patients, DNA was typed for DRB1, DQA1, and DQB1 genes by sequence-specific primer polymerase chain reaction.
In all celiac patients lesions were present in the bulb mucosa. One female with thyroiditis, who had a CD daughter, showed lesions only in the duodenal bulb. Patchy villous atrophy was found in another patient. All celiacs were antiendomysium and/or tTGAb positive. DQ2 heterodimer was present in 5 CD patients. The gastroenterological controls showed normal mucosa in the duodenum.
This study demonstrates that CD-related histologic lesions are present in duodenal bulb of adult patients. Moreover, the normal aspect of this mucosa in gastroenterological controls implies the high negative predictive value of this finding. Therefore, we suggest taking at least 1 biopsy on the bulb area and 1 from the distal duodenum for CD diagnosis, in all the patients submitted to upper endoscopy, to avoid missed or delayed diagnosis.
乳糜泻（CD）相关病变已在乳糜泻患者的十二指肠球部被描述。
我们的目的是评估成人乳糜泻患者和对照组的球部黏膜形态，以评估其对 CD 诊断的有用性。
我们研究了 43 例乳糜泻患者（男 10 例，中位年龄 35.2 岁）和 43 例胃肠病学对照组（男 10 例，中位年龄 37.8 岁），这些患者因胃肠道症状接受了上消化道内镜检查。根据 Marsh 改良分类，由经验丰富的病理学家评估组织学病变。抗肌内膜抗体和抗转谷氨酰胺酶抗体-tTGAb（ELISA 和/或 RIA）已被检测。在选定的患者中，通过序列特异性引物聚合酶链反应对 DRB1、DQA1 和 DQB1 基因进行 DNA 分型。
所有乳糜泻患者的球部黏膜均存在病变。一名患有甲状腺炎的女性，其患有 CD 女儿，仅在十二指肠球部出现病变。另一名患者出现斑片状绒毛萎缩。所有乳糜泻患者均抗肌内膜抗体和/或 tTGAb 阳性。DQ2 异二聚体存在于 5 例 CD 患者中。胃肠病学对照组的十二指肠黏膜正常。
本研究表明，成人患者的十二指肠球部存在与 CD 相关的组织学病变。此外，胃肠病学对照组的这种黏膜正常表明该发现具有较高的阴性预测值。因此，我们建议在上消化道内镜检查的所有患者中，至少在球部区域取 1 个活检，在远端十二指肠取 1 个活检，以避免漏诊或延迟诊断。
