Diagnostic Yield of Duodenal Biopsy Site in Celiac Disease in Children

Abstract

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. Conclusion: 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.