Best Practices in Biopsies for Celiac Disease

This episode of the Raising Celiac Podcast looks at best practices in biopsies for celiac disease. Historically, confirmatory biopsies were obtained from the distal duodenum only, rather than the duodenal bulb. However, researchers have observed that some patients with celiac disease have histopathologic mucosal changes limited to the duodenal bulb only. This subtype, called isolated bulb celiac disease, has been estimated to occur in up to 12% of individuals diagnosed with celiac. Thus, to improve the sensitivity of biopsies in diagnosis, updated pediatric and adult guidelines now recommend obtaining both duodenal bulb and distal duodenum biopsies. But how can delayed diagnosis be prevented in the future? Do endoscopists need to separate the biopsies into separate containers for pathology review? Does isolated blub celiac disease relate at all to the levels of ttg antibodies in the blood? We'll discuss this and more on this episode of Raising Celiac. Thank you to the Global Autoimmune Institute and the Celiac Disease Foundation for their support to make this podcast possible. References: Behl S, et al. The characteristics of isolated bulb celiac disease in children. Journal of Pediatric Gastroenterology and Nutrition. 2023;77:79.