Morphological evaluation of bulb and distal duodenal biopsies in pediatric celiac disease with clinical and serological correlation.

BACKGROUND AND AIMS: An early correct diagnosis of celiac disease (CD) is fundamental to reversal of symptoms and prevention of complications in pediatric patients. Our aim was to evaluate the role of duodenal bulb biopsy by studying the degree of mucosal damage in the duodenal bulb (D1) and second part of the duodenum (D2) and correlating the findings with serum IgA anti-tTG levels. SETTINGS AND DESIGN: Pediatric patients (age <18 years) with clinical suspicion of CD and positive IgA anti-tTG titers were consecutively enrolled over a period of one year. Demographic variables, anthropometry, clinical history, laboratory values and endoscopic findings were studied. Endoscopic biopsies obtained from D1 and D2 were evaluated and assigned histopathologic grades that were correlated with serology. STATISTICAL ANALYSIS USED: Descriptive statistics were employed. RESULTS: A total of 37 clinically suspected cases of pediatric CD were studied. The mean age was 6.7 years and the M:F ratio was 1:1.3. Thirty-two (32) children had varying degrees of growth impairment. Eight (8) children had only extra-intestinal symptoms. Thirty (30) children were anemic, hypoalbuminemia was seen in five (5) children while transaminitis was seen in two (2) children. IgA anti-tTG >300 U/ml was associated with Marsh-Oberhuber Grade 3 morphology at atleast one site. CONCLUSIONS: Low positive serology values should be confirmed by histopathology. Biopsies should be taken even in the absence of endoscopic abnormality. Additional D1 biopsies placed in a separate container can increase the diagnostic yield.

Psychological Dimensions of Celiac Disease in India.

An epidemic of celiac disease is being witnessed in India as well as several other parts of the world. Awareness is important for early diagnosis and treatment so as to avoid long-term morbidity as well as irreversible complications. However, the key for resolution of the disease is good compliance to a gluten-free diet. Unfortunately, the current scenario in India is that either gluten free foods are not easily available or are expensive and often not tested. This is especially true in schools and colleges and smaller towns. In addition, the stigma attached to gluten-free food makes it socially undesirable, and this is made worse by the lack of knowledge among peers, family members, advisors, and even health care providers. We need to make a strong pitch to overcome the confusion regarding the disease as well as the diet to avoid psychological and medical complications.

Non-alcoholic fatty liver disease in children.

A cross sectional study was conducted in 100 children, aged 5 to 12 years, to find the prevalence of non-alcoholic fatty liver diseases (NAFLD), at New Delhi. Those with fatty liver on ultrasonography with no apparent etiology, were labeled as NAFLD. Three (3%) children had evidence of fatty liver on ultrasonography.

Microvillous inclusion disease--an ultrastructural diagnosis: with a review of the literature.

Microvillous inclusion disease is a rare disorder of infancy associated with protracted diarrhea. This malady reveals distinct ultrastructural changes. The surface enterocytes of the duodenum show vesicles lined with microvilli and the surface microvilli are poorly formed. The authors present one case of microvillous inclusion disease with a review of the literature.