Diagnostic Yield of Duodenal Biopsy Site in Celiac Disease in Children

Nashwan M Al Hafidh, Khaldoon Th Al-Abachi, Nazar M Jawhar


Background: Histopathological lesions of celiac disease (CD) were described in the duodenal bulb,
proximal and distal duodenal sites.
Aim: To assess the association between the IgA anti-tTG titer and histological changes in different
duodenal biopsy sites in pediatric patients with CD.
Patients and Methods: A total of 42 symptomatic, seropositive children (21 male and 21 female) with
an age range of 29 to 163 months, underwent oesophagogastroduodenoscopy (OGD). Biopsies were
taken from the first part of the duodenum (bulb), proximal and distal duodenum. The association
between IgA anti-tTG titer and celiac disease histopathological morphology of different duodenal
biopsy sites was assessed.
Results: IgA anti-tTG of ≥ 150 U/ml had a significant relation (p= 0.040) to positive biopsy (marsh
grade 1 -3) results. A cut off value of 126.15 U/ml of IgA anti-tTG titer was significantly (p=0 .000)
associated with sensitivity of 58.6- 63 % with the presence of marsh grade 3 in studied proximal
duodenal site and duodenal bulb site respectively and 1- specificity of 0.00 value in both sites. IgA
tTG of ≥ 150 IU/mL, is significantly (p= 0.0001-0.002) associated with 100% specificity and 100%
positive predictive value of having marsh grade 3 in the examined bulb and proximal duodenal sites.
Our data revealed that high titers of IgA tissue transglutaminase of ≥ 150 U/mL significantly possessed
100 % positive predictive value of yielding marsh grade 3 results in the bulb and proximal duodenal
sites consistent with the diagnosis of celiac disease in symptomatic children. Duodenal bulb and
proximal duodenal sites react similarly concerning the IgA tTG level.


Celiac disease, duodenal biopsy site, IgA tTG level, pediatrics.

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