Celiac Disease: Ten Things That Every Gastroenterologist Should Know

Amy S. Oxentenko; Joseph A. Murray


Clin Gastroenterol Hepatol. 2015;13(8):1396-1404. 

In This Article

3. What Biopsies Should Be Taken to Evaluate for Celiac Disease?

Endoscopically obtained, non-jumbo duodenal biopsies are standard for the evaluation of CD.[18] Studies report that 10%–70% of non-oriented duodenal biopsies were adequate for evaluation.[19,20] Duodenal bulb biopsies increase the diagnostic yield for newly diagnosed CD by 9%–13% and uncover villous atrophy not seen on post-bulbar biopsies in 14% with established CD.[21,22] High sensitivity (100%) was achieved when 4 post-bulbar biopsies were combined with bulb biopsies from both the 9 o'clock and 12 o'clock positions.[3,23] Whether the post-bulbar and bulbar biopsies must be submitted separately versus combined in 1 jar is unclear.

Practical Suggestion

Take 4 biopsies from the post-bulbar duodenum and 1–2 biopsies from the 9 o'clock and/or 12 o'clock position of the bulb (Figure 3).

Figure 3.

Optimal site for biopsy of CD, showing at least 4 samples to be taken from second part of duodenum and 2 samples from duodenal bulb, specifically at the 9 and 12 o'clock positions.