The Benefit of Separate Bulb Biopsy in Children Undergoing an Esophagogastroduodenoscopy

Background: Esophagogastroduodenoscopy (EGD) is an essential diagnostic test in children with gastrointestinal diseases. Small bowel biopsies (SBB) are usually collected from the distal duodenum. A duodenal bulb biopsy (DBB) is recommended in children with celiac disease (CD), because up to 8% can have exclusive bulb injury. This study aims to assess the benefit of separate bulb biopsy in children who underwent EGD and had DBB performed. Methods: We reviewed the electronic medical records between 011998 and 05-2014. All children who underwent an EGD with separate DBB were included. Demographic, clinical, and histopathological parameters were recorded. Results: A total of 211 children were identified. The average age was 10 years (range 1-17 years). Fifty-eight patients had CD, and 153 were non-CD. All patients with CD had positive celiac serology, whereas in non-CD, 10 had positive serology (5 TTG IgG with negative TTG IgA, 1 TTG IgA, and 4 DGP IgG with normal villous architecture). In patients with CD, DBB was diagnostic in 2 (3%) with exclusive bulb injury and confirmatory in 3 (5%) with partial villous atrophy in the bulb and only increased intraepithelial lymphocytes (IEL) distally. In the non-CD group, 7 (4.5%) patients had exclusive bulb injury (4 peptic duodenitis and 3 IEL). Conclusions: In children with CD, DBB increased the diagnostic yield by 9%. In the non-CD group, isolated bulb injury was found in 4.5%, with unclear clinical significance suggesting that DBB may carry higher specificity to CD.