The following is a summary of “Characteristics of Isolated Bulb Celiac Disease in Children,” published in the July 2023 issue of Pediatrics by Behl, et al.

For a study, researchers sought to investigate a cohort of children with isolated bulb celiac disease (CD) and to assess the potential benefits of obtaining separate biopsies from the bulb and distal duodenum during endoscopy.

A retrospective chart review was conducted at two medical centers between January 2011 and January 2022. The study included children with CD who underwent endoscopy with distinct biopsies taken from both the bulb and distal duodenum. A blinded pathologist performed Marsh-Oberhuber grading on selected cases to confirm the diagnosis.

Of 224 CD patients identified, 33 (15%) had histologically confirmed isolated bulb CD. The patients with isolated bulb CD were older at the time of diagnosis compared to those with conventional CD (10 vs 8 years; P = 0.03). Median levels of anti-tissue transglutaminase immunoglobulin A (TTG IgA) were lower in the isolated bulb CD group (2.8 vs 16.7 times the upper limit of normal [ULN], P < 0.001). Nearly 88% (29/33) of isolated bulb CD patients had an anti-TTG IgA value of less than 10 times the ULN. The time to anti-TTG IgA normalization was similar between the two groups (mean 14 months). Interestingly, in almost one-third of the analyzed samples, the pathologist’s analysis of diagnostic biopsies could not tell the distal duodenal biopsies from the bulb biopsies.

Based on the study’s findings, it was suggested that obtaining separate bulb and distal duodenum biopsies can be considered during the diagnosis of CD, especially in children with anti-TTG IgA levels less than 10 times the ULN. Further investigations with larger prospective cohorts are needed to determine whether isolated bulb CD represents a unique subgroup or an early stage of a conventional CD.

Source: journals.lww.com/jpgn/Abstract/2023/07000/The_Characteristics_of_Isolated_Bulb_Celiac.12.aspx