{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T12:32:12Z","timestamp":1784896332482,"version":"3.55.0"},"reference-count":53,"publisher":"Georg Thieme Verlag KG","issue":"11","license":[{"start":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T00:00:00Z","timestamp":1541548800000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background and study aims\u2002Although duodenal biopsy is considered the \u201cgold standard\u201d for diagnosis of celiac disease, the optimal location of biopsy within the small bowel for diagnosis remains unclear. The primary aim of this study was to perform a structured systematic review and meta-analysis to evaluate the diagnostic utility of endoscopic duodenal bulb biopsy for celiac disease.<\/jats:p><jats:p>\n          Patients and methods\u2002Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed from 2000 through December 2017. Review of titles\/abstracts, full review of potentially relevant studies, and data abstraction was performed. Measured outcomes of adult and pediatric patients included location of biopsy, mean number of biopsies performed, and diagnosis of celiac disease as defined by the modified Marsh-Oberhuber classification. <\/jats:p><jats:p>\n          Results\u2002A total of 17 studies (n\u200a=\u200a4050) were included. Seven studies evaluated adults and 11 studies assessed pediatric populations. Mean age of adults and pediatric patients was 46.70 \u00b1 2.69 and 6.33 \u00b1 1.26 years, respectively. Overall, sampling from the duodenal bulb demonstrated a 5\u200a% (95\u200a% CI 3\u200a\u2013\u200a9; P\u200a&lt;\u200a0.001) increase in the diagnostic yield of celiac disease. When stratified by pediatric and adult populations, duodenal bulb biopsy demonstrated a 4\u200a% (95\u200a% CI: 1 to 9; P\u200a&lt;\u200a0.001) and 8\u200a% (95\u200a% CI: 6 to 10; P\u200a&lt;\u200a0.001) increase in the diagnostic yield of celiac disease. Non-celiac histologic diagnoses including Brunner gland hyperplasia and peptic duodenitis were reported more commonly in the duodenal bulb as compared to the distal duodenum with an increase in diagnostic yield of 4\u200a% (95\u200a% CI 3\u200a\u2013\u200a5; P\u200a&lt;\u200a0.001) and 1\u200a% (95\u200a% CI 1\u200a\u2013\u200a2; P\u200a&lt;\u200a0.001), respectively.<\/jats:p><jats:p>\n          Conclusions\u2002Based upon our results, biopsy and histologic examination of duodenal bulb during routine upper endoscopy increases the diagnostic yield of celiac disease. <\/jats:p>","DOI":"10.1055\/a-0732-5060","type":"journal-article","created":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T23:40:29Z","timestamp":1541634029000},"page":"E1369-E1378","source":"Crossref","is-referenced-by-count":50,"title":["Efficacy of duodenal bulb biopsy for diagnosis of celiac disease: a systematic review and meta-analysis"],"prefix":"10.1055","volume":"06","author":[{"given":"Thomas R.","family":"McCarty","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corey R.","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas","family":"Gremida","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Ling","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Rustagi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2018,11,7]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1056\/NEJMra071600","article-title":"Celiac disease","volume":"357","author":"P H Green","year":"2007","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"6036","DOI":"10.3748\/wjg.v18.i42.6036","article-title":"Celiac disease: prevalence, diagnosis, pathogenesis and treatment","volume":"18","author":"N Gujral","year":"2012","journal-title":"World J Gastroenterol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1001\/archinte.163.3.286","article-title":"Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study","volume":"163","author":"A Fasano","year":"2003","journal-title":"Arch Intern Med"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"557","DOI":"10.3109\/07853890.2010.523229","article-title":"Are we not over-estimating the prevalence of coeliac disease in the general population?","volume":"42","author":"F Biagi","year":"2010","journal-title":"Ann Med"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1093\/ajcn\/79.4.669","article-title":"Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease","volume":"79","author":"J A Murray","year":"2004","journal-title":"Am J Clin Nutr"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"3786","DOI":"10.1002\/cncr.26700","article-title":"Increasing incidence of enteropathy-associated T-cell lymphoma in the United States, 1973-2008","volume":"118","author":"R Z Sharaiha","year":"2012","journal-title":"Cancer"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1038\/ajg.2013.79","article-title":"ACG clinical guidelines: diagnosis and management of celiac disease","volume":"108","author":"A Rubio-Tapia","year":"2013","journal-title":"Am J Gastroenterol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1038\/ajg.2010.313","article-title":"Morphometric evaluation of duodenal biopsies in celiac disease","volume":"106","author":"A G Cummins","year":"2011","journal-title":"Am J Gastroenterol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1097\/00042737-199910000-00019","article-title":"The histopathology of coeliac disease: time for a standardized report scheme for pathologists","volume":"11","author":"G Oberhuber","year":"1999","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1016\/j.gie.2010.06.026","article-title":"Prospective study of the role of duodenal bulb biopsies in the diagnosis of celiac disease","volume":"72","author":"S Gonzalez","year":"2010","journal-title":"Gastrointest Endosc"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1016\/j.gie.2010.05.021","article-title":"Bulb biopsies for the diagnosis of celiac disease in pediatric patients","volume":"72","author":"B Mangiavillano","year":"2010","journal-title":"Gastrointest Endosc"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/MCG.0b013e31822d31da","article-title":"Duodenal bulb in celiac adults: the \"whether biopsying\" dilemma","volume":"46","author":"R Nenna","year":"2012","journal-title":"J Clin Gastroenterol"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.MR000022.pub3","article-title":"Search strategies to identify diagnostic accuracy studies in MEDLINE and EMBASE","author":"R Beynon","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"W65","DOI":"10.7326\/0003-4819-151-4-200908180-00136","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"151","author":"A Liberati","year":"2009","journal-title":"Ann Int Med"},{"key":"ref15","first-page":"446","article-title":"Cannabis-induced recurrent acute pancreatitis","volume":"75","author":"M Howaizi","year":"2012","journal-title":"Acta Gastroenterol Belg"},{"key":"ref16","first-page":"468","article-title":"[Recurrent cannabis-induced acute pancreatitis]","volume":"44","author":"A Lorvellec","year":"2015","journal-title":"Presse Med"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.dld.2013.12.005","article-title":"Sampling of proximal and distal duodenal biopsies in the diagnosis and monitoring of celiac disease","volume":"46","author":"R Caruso","year":"2014","journal-title":"Dig Liver Dis"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"339","DOI":"10.2350\/14-03-1451-OA.1","article-title":"Duodenal bulb histological analysis should be standard of care when evaluating celiac disease in children","volume":"17","author":"S Mansfield-Smith","year":"2014","journal-title":"Pediatr Dev Pathol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/MCG.0b013e3181e04d26","article-title":"The role of duodenal bulb biopsy in the diagnosis of celiac disease in children","volume":"45","author":"R Levinson-Castiel","year":"2011","journal-title":"J Clin Gastroenterol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1016\/j.gie.2012.02.025","article-title":"Duodenal bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?","volume":"75","author":"M Kurien","year":"2012","journal-title":"Gastrointest Endosc"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1136\/jclinpath-2012-200874","article-title":"Predictors of duodenal bulb biopsy performance in the evaluation of coeliac disease in children","volume":"65","author":"P Tanpowpong","year":"2012","journal-title":"J Clin Pathol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/jpc.12123","article-title":"Duodenal bulb biopsy in children for the diagnosis of coeliac disease: experience from Perth, Australia","volume":"49","author":"A Sharma","year":"2013","journal-title":"J Paediatr Child Health"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1038\/ajg.2011.171","article-title":"A prospective study of duodenal bulb biopsy in newly diagnosed and established adult celiac disease","volume":"106","author":"K E Evans","year":"2011","journal-title":"Am J Gastroenterol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1097\/MPG.0b013e3181677d6e","article-title":"Duodenal bulb biopsies in celiac disease: a multicenter study","volume":"47","author":"M Bonamico","year":"2008","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/1471-230X-9-78","article-title":"Importance of duodenal bulb biopsies in children for diagnosis of celiac disease in clinical practice","volume":"9","author":"M Rashid","year":"2009","journal-title":"BMC Gastroenterol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/MCG.0b013e31815b9d11","article-title":"Assessment of the diagnostic value of duodenal bulb histology in patients with celiac disease, using multiple biopsy sites","volume":"43","author":"K K Prasad","year":"2009","journal-title":"J Clin Gastroenterol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1097\/00005176-200402000-00019","article-title":"Patchy villous atrophy of the duodenum in childhood celiac disease","volume":"38","author":"M Bonamico","year":"2004","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/j.1572-0241.2005.40669.x","article-title":"Variability of histologic lesions in relation to biopsy site in gluten-sensitive enteropathy","volume":"100","author":"A Ravelli","year":"2005","journal-title":"Am J Gastroenterol"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1016\/j.cgh.2016.02.026","article-title":"Analysis of biopsies from duodenal bulbs of all endoscopy patients increases detection of abnormalities but has a minimal effect on diagnosis of celiac disease","volume":"14","author":"S A Stoven","year":"2016","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1053\/j.gastro.2016.01.029","article-title":"Clinical and immunologic features of ultra-short celiac disease","volume":"150","author":"P D Mooney","year":"2016","journal-title":"Gastroenterology"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/S0140-6736(17)31796-8","article-title":"Coeliac disease","volume":"391","author":"B Lebwohl","year":"2018","journal-title":"Lancet"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.bpg.2005.01.004","article-title":"Coeliac disease in developing countries: Middle East, India and North Africa","volume":"19","author":"R Malekzadeh","year":"2005","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1038\/ajg.2012.219","article-title":"The prevalence of celiac disease in the United States","volume":"107","author":"A Rubio-Tapia","year":"2012","journal-title":"Am J Gastroenterol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/j.1651-2227.1996.tb14244.x","article-title":"The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects","volume":"412","author":"C Catassi","year":"1996","journal-title":"Acta Paediatr Suppl"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1097\/MCG.0000000000000919","article-title":"World Gastroenterology Organisation Global Guidelines: Celiac Disease February 2017","volume":"51","author":"J C Bai","year":"2017","journal-title":"J Clin Gastroenterol"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1097\/MPG.0000000000001216","article-title":"NASPGHAN Clinical report on the diagnosis and treatment of gluten-related disorders","volume":"63","author":"I D Hill","year":"2016","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1001\/jama.2017.1462","article-title":"Screening for Celiac Disease: US Preventive Services Task Force Recommendation Statement","volume":"317","author":"U SPST Force","year":"2017","journal-title":"JAMA"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"h4513","DOI":"10.1136\/bmj.h4513","article-title":"Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance","volume":"351","author":"L Downey","year":"2015","journal-title":"BMJ"},{"key":"ref39","first-page":"28","article-title":"Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue","volume":"38","author":"C E Rubin","year":"1960","journal-title":"Gastroenterology"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1136\/bmj.3.5823.371","article-title":"Lymphocytic infiltration of epithelium in diagnosis of gluten-sensitive enteropathy","volume":"3","author":"L Fry","year":"1972","journal-title":"Br Med J"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/0016-5085(92)91819-P","article-title":"Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue')","volume":"102","author":"M N Marsh","year":"1992","journal-title":"Gastroenterology"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/0950-3528(95)90032-2","article-title":"Morphology of the mucosal lesion in gluten sensitivity","volume":"9","author":"M N Marsh","year":"1995","journal-title":"Baillieres Clin Gastroenterol"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1136\/gut.34.2.150","article-title":"Clinical and pathological spectrum of coeliac disease \u2013 active, silent, latent, potential","volume":"34","author":"A Ferguson","year":"1993","journal-title":"Gut"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/j.1651-2227.1996.tb14240.x","article-title":"Latent and potential coeliac disease","volume":"412","author":"R Troncone","year":"1996","journal-title":"Acta Paediatr Suppl"},{"key":"ref45","first-page":"10","article-title":"Small intestinal biopsy: diagnostic and research value","volume":"52","author":"M Shiner","year":"1959","journal-title":"Proc R Soc Med"},{"key":"ref46","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1055\/s-2007-995361","article-title":"Patchy villous atrophy in adult patients with suspected gluten-sensitive enteropathy: is a multiple duodenal biopsy strategy appropriate?","volume":"40","author":"A D Hopper","year":"2008","journal-title":"Endoscopy"},{"key":"ref47","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1055\/s-2001-13702","article-title":"Diagnostic duodenal bulb biopsy in celiac disease","volume":"33","author":"H Vogelsang","year":"2001","journal-title":"Endoscopy"},{"key":"ref48","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.prp.2012.01.008","article-title":"Tricks of the trade: How to avoid histological pitfalls in celiac disease","volume":"208","author":"A Ravelli","year":"2012","journal-title":"Pathol Res Pract"},{"key":"ref49","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1053\/j.gastro.2006.10.003","article-title":"AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease","volume":"131","author":"Institute AGA","year":"2006","journal-title":"Gastroenterology"},{"key":"ref50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00005176-200501000-00001","article-title":"Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition","volume":"40","author":"I D Hill","year":"2005","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1056\/NEJM197112232852607","article-title":"Diagnostic value of peroral biopsy of the proximal small intestine","volume":"285","author":"J S Trier","year":"1971","journal-title":"N Engl J Med"},{"key":"ref52","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/j.cgh.2007.03.019","article-title":"Comparison of the interobserver reproducibility with different histologic criteria used in celiac disease","volume":"5","author":"G R Corazza","year":"2007","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref53","first-page":"774","article-title":"Optimal approach to obtaining mucosal biopsies for assessment of inflammatory disorders of the gastrointestinal tract","volume":"104","author":"R K Yantiss","year":"2009","journal-title":"Am J Gastroenterol"}],"container-title":["Endoscopy International Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-0732-5060.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T11:38:45Z","timestamp":1596541125000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-0732-5060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":53,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2018,11,7]]},"published-print":{"date-parts":[[2018,11]]}},"URL":"https:\/\/doi.org\/10.1055\/a-0732-5060","relation":{},"ISSN":["2364-3722","2196-9736"],"issn-type":[{"value":"2364-3722","type":"print"},{"value":"2196-9736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}