الفهرس 
C ELIAC D ISEASEOnly 14 pages are availabe for public view
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Abstract
ABSTRACT
Background: The diagnosis of celiac disease relies on a combination of clinical evaluation, serological testing, and histopathological examination of duodenal biopsies. However, there is ongoing debate regarding the optimal number of duodenal biopsies required for an accurate diagnosis, as well as the isolated yield of water interface directed biopsy.
Aim: The primary objective is to determine the cumulative benefit of multiple duodenal biopsies, establishing the specificity and sensitivity of each biopsy separately with focus on the isolated yield of water interface directed biopsy.
Methods: A Cross-sectional study conducted on 22 children with symptoms and signs suggestive of CD and positive serology at the pediatric GIT Endoscopy Unit at EL Demerdash Hospital, Ain Shams University for 6 months. four biopsies were taken,one from duodenal bulb,and 2 from rest of duodenum and The fourth one using water immersion technique visualizing the most affected area.
Results Out of the 22 enrolled children, 18 patient were histopathologically positive for celiac disease and 4 children were negative. The bulb, duodenal, and water interface biopsies were positive in 94.4%, 88.8%, and 66.7% respectively, of the positively diagnosed celiac disease by Marsh criteria. While all biopsies were negative in 100% of the negatively diagnosed by Marsh criteria p-value<0.05. In addition, bulb, and duodenal biopsies have the highest sensitivity of 94.4%, and 88.9%, respectively, also, they have the highest accuracy of 0.955, and 0.909, respectively..Duodenal bulb biopsies were capable alone to diagnose 17out of 18 definite cases. The missed case diagnosis was reached either by water interface or any random duodenal biopsy.
Conclusion: Bulb biopsy showed to be the most accurate in diagnosing celiac disease, on the contrary, water interface biopsy was not sensitive in diagnoses, so the celiac diagnostic efficacy can be reached by assessment of 2 duodenal biopsies,one of them from the duodenal bulb.