Coeliac disease (CD) is an autoimmune enteropathy which can present with patchy mucosal lesions. The aim of the present study is to investigate the significance of duodenal bulb biopsy in the diagnostic work-up of CD in both pediatric and adult patients, and to highlight the key points for pathologists. D1 (duodenal bulb) and D2 (distal duodenum) biopsies of 153 newly diagnosed serology-positive CD patients were evaluated for villous/crypt ratio and intraepithelial lymphocyte (IEL) counts on CD3-stained slides and were classified according to Marsh. Mucosal pathology was patchy in 15% (13% only D1 and 2% only D2) of patients, and 85% of patients had diffuse mucosal pathology involving both D1 and D2 biopsies which showed concordant histology in 60% and discordant in 25% of the cases. Though majority of the patients (75%) with only D1 involvement were pediatric cases, no significant difference was found between pediatric and adult patients when all cases were considered (17 vs 14%). Our results clearly indicate that without D1 sampling, diagnosis of CD would have been missed in a significant number of cases (13%), thereby highlighting the importance of taking duodenal biopsies from multiple sites in the diagnostic work-up of CD. We, therefore, conclude that every biopsy piece from both D1 and D2 should be carefully evaluated for the whole spectrum of mucosal changes caused by gluten ingestion and classified using a scheme based on Marsh to allow recognition of mild lesions.

中文翻译：

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十二指肠球囊活检在乳糜泻的诊断中的作用。

腹腔疾病（CD）是一种自身免疫性肠病，可出现斑块状的粘膜病变。本研究的目的是调查十二指肠球囊活检在小儿和成年患者的CD诊断中的意义，并突出病理学家的重点。对153名新诊断的血清学阳性CD患者的D1（十二指肠球）和D2（远端十二指肠）活检进行了CD3染色载玻片上的绒毛/隐窝比率和上皮内淋巴细胞（IEL）计数评估，并根据Marsh分类。15％（仅D1为13％，仅D2为2％）患者的黏膜病理学不规则，并且85％的患者具有D1和D2活检的弥漫性黏膜病理学，在60％的患者中组织学一致，在25％的患者中不一致。案件。尽管只有D1参与的大多数患者（75％）是儿科病例，但考虑所有病例后，儿科患者与成年患者之间没有发现显着差异（17％vs 14％）。我们的结果清楚地表明，如果没有D1采样，在很多情况下（13％）会漏诊CD的诊断，从而突出了在CD的诊断工作中从多个部位进行十二指肠活检的重要性。因此，我们得出结论，应仔细评估D1和D2的每个活检片，以评估由麸质摄入引起的粘膜变化的整个范围，并使用基于Marsh的方案进行分类，以识别轻度病变。我们的结果清楚地表明，如果没有D1采样，在很多情况下（13％）会漏诊CD的诊断，从而突出了在CD的诊断工作中从多个部位进行十二指肠活检的重要性。因此，我们得出结论，应仔细评估D1和D2的每个活检片，以评估由麸质摄入引起的粘膜变化的整个范围，并使用基于Marsh的方案进行分类，以识别轻度病变。我们的结果清楚地表明，如果没有D1采样，在很多情况下（13％）会漏诊CD的诊断，从而突出了在CD的诊断工作中从多个部位进行十二指肠活检的重要性。因此，我们得出结论，应仔细评估D1和D2的每个活检片，以评估由麸质摄入引起的粘膜变化的整个范围，并使用基于Marsh的方案进行分类，以识别轻度病变。