Immunohistologic analysis of the duodenal bulb

Post written by Tarcisio Not, MD, from the Institute for Maternal and Child Health–IRCCS “Burlo Garofolo” Trieste, Trieste, Italy.

This prospective study investigates whether histological analysis of the duodenal bulb combined with intestinal IgA anti-tissue transglutamonase deposit immunoassay makes celiac disease diagnosis possible in at-risk children with low concentrations of serum anti-tissue transglutaminase.

Anti-tissue transglutaminase antibodies have simplified celiac disease diagnosis. However, in atypical forms of celiac disease, intestinal biopsy is still required. In these cases gastroenterologists have to pay attention to both the intestinal site from where to collect biopsies and the kind of analysis to perform in order to enable a correct diagnosis of celiac disease.

In children at risk for celiac disease, bulb duodenum biopsy is essential to identify villous atrophy and, especially, to detect IgA anti-tissue transglutaminase deposits even in the absence of intestinal lesions (Fig. 1).  This last condition in symptomatic subjects is becoming more and more frequent in clinical practice and can be solved effectively by using immunological techniques to detect anti-transglutaminase antibodies in the intestinal mucosa. These mucosal autoantibodies could well represent a new standard for diagnosing celiac disease. Therefore, it would be important to simplify the detection of these intestinal antibodies and allow a widespread use of this immunological analysis in all clinical centers.



Figure 1. Immunohistologic and serologic characteristics of the 4 study groups. The cut-off limit of our serum IgA anti-tTG assay is 7 U/mL. Serum IgA anti-tTG concentrations up to 37 U/mL are predictive of intestinal damage extended to the entire duodenum. IgA anti-tTG concentrations are statistically different among the 3 CD study groups. Inline Image fx1, Intestinal atrophy; Inline Image fx2, intestinal IgA anti-tTG deposits. Anti-tTG, Antibodies against the tissue transglutaminase enzyme.


Read the full article online.

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