{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T11:44:18Z","timestamp":1782906258048,"version":"3.54.5"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Duodenal involvement in celiac disease (CD) can be patchy, with a subset of patients demonstrating histopathological involvement limited to the bulb. This study evaluates whether bulb\u2010restricted CD represents a distinct subgroup associated with lower titers of immunoglobulin A anti\u2010tissue transglutaminase antibody (TTG\u2010IgA) compared to distal duodenal CD in pediatric patients. Additionally, we assess the impact of a no\u2010biopsy approach for pediatric CD with TTG\u2010IgA \u226510 times the upper limit of normal (TTG\u2010IgA \u226510\u00d7 ULN) on the relative frequency of bulb\u2010restricted CD among biopsied patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Incident pediatric CD cases were identified retrospectively between 2017 and 2022. A no\u2010biopsy approach for TTG\u2010IgA \u226510\u00d7 ULN was locally implemented in 2020. Serum TTG\u2010IgA was categorized as negative, equivocal, positive TTG\u2010IgA &lt;10\u00d7 ULN, and positive TTG\u2010IgA\u2265 10\u00d7 ULN. Biopsies were classified by Marsh score and site of involvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 405 cases included (mean age\u2009=\u20099.6 years, female\u2010to\u2010male ratio\u2009=\u20092.1:1), bulb\u2010restricted CD was present in 7.4%. TTG\u2010IgA was negative or equivocal in 60.0% of bulb\u2010restricted CD, compared to 5.3% of distal duodenal CD (odds ratio [OR]\u2009=\u200926.6; 95% confidence interval [CI]\u2009=\u2009[11.1\u201363.3], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Notably, no bulb\u2010restricted CD cases attained TTG\u2010IgA \u226510\u00d7 ULN, compared to 48.5% of distal duodenal CD. Following local implementation of the no\u2010biopsy approach for TTG\u2010IgA \u226510\u00d7 ULN, the relative percentage of bulb\u2010restricted CD significantly increased from 4.6% to 12.4% (OR\u2009=\u20092.9, 95% CI\u2009=\u2009[1.4\u20136.4], <jats:italic>p<\/jats:italic>\u2009=\u20090.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pediatric CD with isolated bulb pathology presents with lower serum TTG\u2010IgA titers than cases with distal duodenal involvement. Implementation of the no\u2010biopsy approach increased the relative proportion of bulb\u2010limited CD, as these cases were not associated with TTG\u2010IgA \u226510\u00d7 ULN.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpn3.12474","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T07:30:51Z","timestamp":1738222251000},"page":"678-685","source":"Crossref","is-referenced-by-count":3,"title":["Low TTG\u2010IgA associated with isolated bulb pathology in pediatric celiac disease: Implications in a no\u2010biopsy approach era"],"prefix":"10.1002","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2633-6800","authenticated-orcid":false,"given":"Qing Yin","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pr\u00e9vost","family":"Jantchou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Unit of Gastroenterology and Hepatology Centre Hospitalier Universitaire Sainte\u2010Justine Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Dirks","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Unit of Gastroenterology and Hepatology Centre Hospitalier Universitaire Sainte\u2010Justine Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien B.","family":"Lavoie","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry Centre Hospitalier Universitaire Sainte\u2010Justine Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc L.","family":"Oligny","sequence":"additional","affiliation":[{"name":"Department of Pathology Centre Hospitalier Universitaire Sainte\u2010Justine Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doroth\u00e9e","family":"Dal Soglio","sequence":"additional","affiliation":[{"name":"Department of Pathology Centre Hospitalier Universitaire Sainte\u2010Justine Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natacha","family":"Patey","sequence":"additional","affiliation":[{"name":"Department of Pathology Centre Hospitalier Universitaire Sainte\u2010Justine Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12920-016-0211-8"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002497"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002075"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e3181677d6e"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2013.12.005"},{"issue":"2","key":"e_1_2_8_7_1","first-page":"204","article-title":"Patchy villous atrophy of the duodenum in childhood celiac disease","volume":"38","author":"Bonamico M","year":"2004","journal-title":"J Pediatr Gastroenterol 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