The following is a summary of “Characteristics of Isolated Bulb Celiac Disease in Children,” published in the July 2023 issue of the Pediatric Gastroenterology and Nutrition by Behl et al.
Mucosal damage in individuals with celiac disease (CD) can exhibit a patchy pattern, and approximately 12% of CD patients may present with mucosal alterations confined solely to the duodenal bulb. Therefore, recent medical guidelines suggest acquiring bulb biopsies with distal duodenum. The objective of this study was to provide a comprehensive description of a group of pediatric patients diagnosed with isolated bulb CD and evaluate the potential advantages of performing separate bulb biopsies. A retrospective medical record analysis was conducted at two healthcare facilities, covering January 2011 to January 2022. Researchers enrolled pediatric patients diagnosed with CD who underwent an endoscopic procedure with separate biopsies obtained from the duodenal bulb and distal duodenum.
A visually impaired pathologist conducted Marsh-Oberhuber grading on specific cases. Researchers have identified 224 patients with CD (Crohn’s disease), of which 33 individuals (15%) were diagnosed with isolated bulb CD based on histological confirmation. Patients diagnosed with remote bulb CD presented at an older age (10 years compared to 8 years; P = 0.03). The median level of anti-tissue transglutaminase immunoglobulin A (TTG IgA) was found to be lower in isolated bulbous Crohn’s disease (CD) compared to the upper limit of normal (ULN), with a significant difference of 2.8 times vs 16.7 times the ULN (P < 0.001). Approximately 88% (29 out of 33) of patients diagnosed with isolated bulb CD exhibited an anti-TTG IgA level below 10 times the upper limit of normal (ULN).
The duration required for anti-tissue transglutaminase immunoglobulin A (anti-TTG IgA) normalization (with an average of 14 months) was comparable in both cohorts. Approximately one-third of the reviewed samples underwent a pathologist’s evaluation of diagnostic biopsies but could not differentiate between the bulb and distal duodenum biopsies. The option of obtaining biopsies from the bulb and distal duodenum may be considered for diagnosing CD, especially in pediatric patients exhibiting anti-TTG IgA levels that are less than 10 times the upper limit of normal (ULN). Additional prospective cohorts are required to determine whether isolated bulb Crohn’s disease (CD) represents a distinct cohort or an initial phase of a conventional CD.