Value of Duodenal Bulb Biopsy in the Diagnosis of Celiac Disease in a Group of Iranian Children

Background: Studies have shown that Celiac Disease (CD) can present with patchy mucosal lesions. The aim of this study is to investigate the utility of duodenal bulb biopsy in the diagnosis of CD in some Iranian children. Moreover, we compare disease characteristics in children with CD consistent histology limited to the duodenal bulb (D1) with those of children with CD-related histology in the second part of duodenum (D2) with or without histology changes in D1. Methods: This is a cross sectional study on anti-tissue transglutaminase antibody (anti TTG Ab) positive children in Mashhad between 2019 and 2021. Intestinal biopsies from D1 and D2 were done. Diagnosis of CD was defined by the Marsh classification above 1. Patients of 2 groups compared in terms of clinical and laboratory parameters. Results: from 81 serology positive patients, 70 patients were diagnosed with CD, based on Marsh classification. Among them, 6 patients (8.6%) had exclusive involvement of D1, and 64 cases (91%) had involvement of D2 with or without D1. The two groups did not have a statistically significant difference in terms of clinical presentation, serological and histopathological values. Conclusion: Taking D1 biopsies can improve case finding of CD in the pediatric population.