Anuj Walia*, KK Prasad**, S Lal***, BR Thapa****
Division of Pediatric Gastroenterology, Dept of Gastroenterology,
Post Graduate Institute of Medical Education & Research *, Division of Pediatric Gastroenterology, Dept of Gastroenterology,
Post Graduate Institute of Medical Education & Research **, Division of Pediatric Gastroenterology, Dept of Gastroenterology,
Post Graduate Institute of Medical Education & Research ***, Division of Pediatric Gastroenterology, Dept of Gastroenterology,
Post Graduate Institute of Medical Education & Research ****
Celiac disease (CD) is being reported from North India. Earlier the Crosby capsule biopsies taken from the jejunum and more recently the endoscopic biopsies from the second part of duodenum show changes of CD. There is evidence to indicate that endoscopic biopsies from the first part of duodenum can be equally representative of the disease.
Aim: To study and compare the histological changes in the first (D1) and second (D2) part of duodenum in suspected cases of celiac disease prospectively.
Materials & Methods: All the cases of suspected CD attending Celiac disease clinic at PGIMER, Chandigarh from July 2005 onwards were enrolled for the study. Their detailed history and examination were recorded. All children underwent routine hemogram, liver function tests, stool routine tests, serum calcium, serum phosphorus, tissue transglutaminase antibody (tTGA) levels. All patients with positive tTGA levels underwent upper gastrointestinal endoscopy and biopsies from D1 and D2 part of the duodenum. The changes in the duodenum in endoscopy were recorded and 3 biopsies each were taken from D1 and D2, fixed in formalin and sent for histopathological examination. The biopsies were examined by a single pathologist and he was blinded about the site of biopsy. The children were diagnosed as cases of celiac disease based on the modified ESPGHAN criteria and diagnosed patients were put on gluten free diet.
Results: 38 children were enrolled in the study. The M:F ratio was 1:0.35. The mean tissue trans glutaminase levels were 108 IU/ml. The mean age of diagnosis was 7.5 years. All the children showed features of grooving and scalloping in the duodenum. There were 7421.87 intraepithelial lymphocytes in D1 and 72.47 20.04 in D2 and the difference was not statistically significant. Subtotal villous atrophy was observed in D1 in 65.78% cases while in D2 it was 68.42%. Partial villous atrophy in D1 was seen in 34.22% cases while in D2 it was 31.57% cases. All the children showed a clinical improvement on gluten-free diet.
Conclusion: Biopsies from the first and second part of duodenum in freshly diagnosed cases of CD can be equally representative of the underlying disease.
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