Muhammad Khalid Masood, Sadia Sharif, Riffat Omar, Sohail Ahmed.
Histopathological Correlation of Duodenal Biopsies in Diagnosing Celiac Disease in Pediatric Patients.
Pak Paed J Jan ;42(3):191-6.

Background: Celiac disease (CD) is a chronic intestinal disorder due to immune mediated hyper-responsiveness of human body to gluten and similar proteins. It has been noticed that a large number of celiac individuals are not properly worked up and diagnosed; this may be because of the reason that celiac disease may have diverse presentation and many physicians are not aware of this condition, so they do not consider this disorder in their routine practice. It has been pointed out by many researchers that histopathological findings of CD are also present in proximal duodenal apart from distal duodenum and sometime duodenal bulb is the only site showing changes. This study was designed to see the distribution of histological lesions and also to see the frequency of lesions in duodenal bulb mucosa and distal duodenum. If the degree of agreement is high between the two biopsy sites then it can be recommended to take biopsy from duodenal bulb alone. Objective: To determine the degree of agreement between the biopsy taken from the duodenal bulb and from its distal part for diagnosis of patients with suspected celiac disease. Methodology: This cross sectional study was conducted in Department of Pediatrics, Mayo Hospital, Lahore for duration of 6 months from March 2014 to September 2014 after getting approval from hospital ethical committee. Total 102 cases were included in the study through non-probability purposive sampling technique. Informed written consent and demographic data were obtained. Upper GI endoscopy was done under general anesthesia and one sample was taken from area of duodenal bulb and four from distal duodenum. Presence or absence of histological changes of CD was recorded to determine the agreement. The modified Marsh Oberhuber classification was followed for histological diagnosis and grading. Data was entered and analyzed by using computer software SPSS 16. Results: The mean age of the patients was 7.86±3.59 years. The mean weight of the patients was 16.06±5.03 Kg and 96.55±8.029cm respectively. In this study, the positive degree of agreement was found in 98.04% patients whereas it was found negative in just 1.96% patients. Conclusion: A strong agreement is found a correlation degree of agreement between the two biopsy sites. Now we are able to recommend taking biopsy from duodenal bulb alone.

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