Duodenal bulb biopsy for the diagnosis of coeliac disease

摘要

I read with great interest the findings of Sharma et al.1 that may prove of paramount importance for the diagnosis yield of coeliac disease (CD) in children. They reported that 8 (7.92%) of 101 children had biopsy changes consistent with CD (Marsh 3 atrophic-type lesions in the context of positive coeliac serology) that is exclusively limited to the duodenal bulb with normal histology in the distal duodenum. They rightly emphasise that if bulb biopsy is not undertaken, CD could be potentially missed, and acknowledge the limitation of their retrospective observational study with a small sample size.