The frequency of histologic lesion variability of the duodenal mucosa in children with celiac disease
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The frequency of histologic lesion variability of the duodenal mucosa in children with celiac disease Kaushal Kishor Prasad, Babu Ram Thapa, Chander Kanwal Nain, Kartar Singh Chandigarh, India
Original article 60
Background: 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. Methods: 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. Results: 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. Conclusions: 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. World J Pediatr 2010;6(1):60-64
Author Affiliations: Department of Superspeciality of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh (UT) - 160 012, India (Prasad KK, Thapa BR, Nain CK, Singh K) Corresponding Author: Kaushal Kishor Prasad, MD, PDC, Division of GE Histopathology, Department of Superspeciality of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh (UT) -160 012, India (Tel: +91-172-2756604; Fax: +91-172-2744401, 2744450; Email: [email protected]) doi:10.1007/s12519-010-0008-3 ©2010, World J Pediatr. All rights reserved.
Key words: celiac disease; duodenum; histologic lesion; villous atrophy
Introduction
C
eliac disease (CD) is a permanent condition of gluten intolerance in which exposure to gluten results in characteristic pathologic changes in the gastrointestinal tract, most notably in the small intestine, where the histologic features include villous atrophy (VA), crypt hyperplasia, mononuclear cell infiltration of the lamina propria, and a pronounced intraepithelial lymphocytosis. The diagnosis of CD requires recognition of characteristic pathologic changes in an intestinal biopsy, accompanied by clinical and/or histologic improvement on a glutenfree diet.[1] Positive serologic tests are supportive of the diagnosis but not necessary.[1] The gluten sensitivity can produce
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