Wang Qing Yin, Jantchou Prévost, Dirks Martha, Lavoie Sébastien B, Oligny Luc L, Dal Soglio Dorothée, Patey Natacha
Department of Internal Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
Department of Pediatrics, Unit of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.
J Pediatr Gastroenterol Nutr. 2025 Apr;80(4):678-685. doi: 10.1002/jpn3.12474. Epub 2025 Jan 29.
Duodenal involvement in celiac disease (CD) can be patchy, with a subset of patients demonstrating histopathological involvement limited to the bulb. This study evaluates whether bulb-restricted CD represents a distinct subgroup associated with lower titers of immunoglobulin A anti-tissue transglutaminase antibody (TTG-IgA) compared to distal duodenal CD in pediatric patients. Additionally, we assess the impact of a no-biopsy approach for pediatric CD with TTG-IgA ≥10 times the upper limit of normal (TTG-IgA ≥10× ULN) on the relative frequency of bulb-restricted CD among biopsied patients.
Incident pediatric CD cases were identified retrospectively between 2017 and 2022. A no-biopsy approach for TTG-IgA ≥10× ULN was locally implemented in 2020. Serum TTG-IgA was categorized as negative, equivocal, positive TTG-IgA <10× ULN, and positive TTG-IgA≥ 10× ULN. Biopsies were classified by Marsh score and site of involvement.
Of the 405 cases included (mean age = 9.6 years, female-to-male ratio = 2.1:1), bulb-restricted CD was present in 7.4%. TTG-IgA was negative or equivocal in 60.0% of bulb-restricted CD, compared to 5.3% of distal duodenal CD (odds ratio [OR] = 26.6; 95% confidence interval [CI] = [11.1-63.3], p < 0.001). Notably, no bulb-restricted CD cases attained TTG-IgA ≥10× ULN, compared to 48.5% of distal duodenal CD. Following local implementation of the no-biopsy approach for TTG-IgA ≥10× ULN, the relative percentage of bulb-restricted CD significantly increased from 4.6% to 12.4% (OR = 2.9, 95% CI = [1.4-6.4], p = 0.004).
Pediatric CD with isolated bulb pathology presents with lower serum TTG-IgA titers than cases with distal duodenal involvement. Implementation of the no-biopsy approach increased the relative proportion of bulb-limited CD, as these cases were not associated with TTG-IgA ≥10× ULN.
乳糜泻（CD）累及十二指肠时可能呈斑片状，部分患者的组织病理学累及仅限于十二指肠球部。本研究评估在儿科患者中，局限于球部的CD是否代表一个与抗组织转谷氨酰胺酶抗体（TTG-IgA）滴度较低相关的独特亚组，与十二指肠远端CD相比。此外，我们评估了对于TTG-IgA≥正常上限10倍（TTG-IgA≥10×ULN）的儿科CD采用非活检方法对活检患者中局限于球部的CD相对频率的影响。
回顾性确定2017年至2022年间确诊的儿科CD病例。2020年在当地实施了针对TTG-IgA≥10×ULN的非活检方法。血清TTG-IgA分为阴性、可疑、阳性TTG-IgA<10×ULN和阳性TTG-IgA≥10×ULN。活检按马什评分和累及部位分类。
纳入的405例病例（平均年龄=9.6岁，男女比例=2.1:1）中，局限于球部的CD占7.4%。局限于球部的CD中60.0%的TTG-IgA为阴性或可疑，而十二指肠远端CD中这一比例为5.3%（优势比[OR]=26.6；95%置信区间[CI]=[11.1 - 63.3]，p<0.001）。值得注意的是，局限于球部的CD病例中没有TTG-IgA≥10×ULN的情况，而十二指肠远端CD中有48.5%是这种情况。在当地实施针对TTG-IgA≥10×ULN的非活检方法后，局限于球部的CD相对百分比从4.6%显著增加到12.4%（OR=2.9，95%CI=[1.4 - 6.4]，p=0.004）。
孤立球部病变的儿科CD患者血清TTG-IgA滴度低于十二指肠远端受累的病例。非活检方法的实施增加了局限于球部的CD的相对比例，因为这些病例与TTG-IgA≥10×ULN无关。
