Boschee Erin, Lacson Atilano, Turner Justine, Yap Jason
Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.
J Can Assoc Gastroenterol. 2020 Oct;3(5):210-215. doi: 10.1093/jcag/gwz014. Epub 2019 May 17.
Controversy exists about optimal methods for duodenal biopsy in diagnosis of celiac disease (CD), in terms of both number of samples and anatomic location. The reliability of duodenal bulb biopsy has been questioned given that normal bulb architecture may mimic disease. However, multiple studies have reported patients with CD have histopathological lesions limited to proximal changes in the duodenal bulb alone.
We retrospectively compared duodenal and duodenal bulb histology in a population of paediatric patients with CD and compared with a population of nonceliac controls at Stollery Children's Hospital, 2010 to 2012.
Fifty-seven paediatric patients diagnosed with CD and 16 nonceliac controls were included in the study. Fifty-three celiac patients (93.0%) had histopathology consistent with CD (modified Marsh score of 3A, 3B or 3C) in the duodenal bulb. The modified Marsh classification differed significantly between duodenum and duodenal bulb in nine celiac patients (15.8%). Of these, five (8.8%) had Marsh 3 in the bulb and Marsh 0 in the distal duodenum. Among controls, no patients had villous atrophy in either the distal duodenum or duodenal bulb, and all patients had a modified Marsh score of 0 at both sites.
The results of this study reinforce that duodenal bulb samples are critically important for diagnosing CD in paediatric patients. We suggest that duodenal bulb samples be submitted in separate containers from distal duodenal samples to facilitate accurate interpretation. In contrast to prior reports, we found villous blunting and intraepithelial lymphocytosis are actually uncommon findings in paediatric patients with nonceliac gastrointestinal disorders.
关于乳糜泻（CD）诊断中十二指肠活检的最佳方法，在样本数量和解剖位置方面均存在争议。鉴于十二指肠球部的正常结构可能类似疾病表现，十二指肠球部活检的可靠性受到质疑。然而，多项研究报告称，患有CD的患者组织病理学病变仅局限于十二指肠球部近端的改变。
我们回顾性比较了2010年至2012年在斯托雷里儿童医院的一组患有CD的儿科患者的十二指肠和十二指肠球部组织学，并与一组非乳糜泻对照人群进行了比较。
本研究纳入了57例被诊断为CD的儿科患者和16例非乳糜泻对照。53例乳糜泻患者（93.0%）十二指肠球部的组织病理学与CD相符（改良马什评分为3A、3B或3C）。9例乳糜泻患者（15.8%）十二指肠和十二指肠球部的改良马什分类存在显著差异。其中，5例（8.8%）球部为马什3级，十二指肠远端为马什0级。在对照组中，没有患者在十二指肠远端或十二指肠球部出现绒毛萎缩，所有患者在这两个部位的改良马什评分均为0。
本研究结果强化了十二指肠球部样本对儿科患者CD诊断至关重要的观点。我们建议将十二指肠球部样本与十二指肠远端样本分别装在不同容器中送检，以便于准确解读。与先前的报告相反，我们发现绒毛变钝和上皮内淋巴细胞增多在患有非乳糜泻性胃肠疾病的儿科患者中实际上并不常见。
