Biopsies from the duodenal bulb (D1) and the second portion of the duodenum (D2) were found to provide similar diagnostic value for adult-onset celiac disease (CeD), according to study results published in the Journal of Clinical Gastroenterology.
Obtaining a diagnosis of adult-onset CeD can be challenging. Current guidelines recommend for multiple biopsies from D1 and D2 to be considered; however, no consensus has been established on the optimal number of biopsies from each location.
Researchers conducted a systematic review and meta-analysis to assess the diagnostic utility of various biopsy scenarios in the setting of adult-onset CeD. To that end, publication databases were searched through January 2023 for studies evaluating the diagnostic yield of biopsy samples from the duodenal bulb (D1) compared with the duodenum (D2).
A total of 16 studies with 1617 patients aged over 18 (mean range, 32-57) years were included in the analysis. Most studies (n=12) were of a prospective design, and the studies were published between 2001 and 2021.
Overall, the pooled diagnostic rates of D1 (77.4%; 95% CI, 64.7%-86.5%; I2, 96%) and D2 (75.3%; 95% CI, 60.8%-85.7%; I2, 96%) did not differ significantly (P =.8).
Stratified by number of biopsies obtained in each study, the pooled diagnostic rates of 4 biopsy samples from D1 (83.3%; 95% CI, 49.8%-96.2%; I2, 76%) and D2 (70.5%; 95% CI, 51%-84.6%; I2, 96%) did not differ significantly (P =.3). Similar trends were observed from studies that obtained 2 biopsy samples from D1 (77.3%; 95% CI, 50%-92%; I2, 93%) and D2 (86.4%; 95% CI, 58.4%-96.7%; I2, 87%).
When the diagnostic yield was assessed on the basis of number of biopsies, the accuracy of D1 and D2 biopsies were similar in studies that obtained 4 (P =.3) and 2 (P =.7) samples.
In the subgroup analyses, no significant trends were observed. However, 1 comparison trended toward significance (P =.07), in which D2 biopsies tended to have a higher diagnostic yield (8.1%; 95% CI, 5.5%-11.8%; I2, 30%) than D1 biopsies (4.7%; 95% CI, 2.9%-7.4%; I2, 25%) from Marsh category 2 lesions.
The major limitation of this analysis was that no data were collected from randomized trials.
“[T]his meta-analysis shows that diagnostic yield from biopsies from the first and second part of the duodenum for patients with adult-onset celiac disease is similar; however, in those with a patchy distribution of the disease, duodenal bulb biopsy can help diagnosing additional cases,” study authors noted. “There is no additional benefit to taking 4 biopsy samples over 2 biopsy samples from each duodenal segment.”
Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.
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