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PTH-183 The Diagnostic Utility of Endoscopic Duodenal Biopsies for Gastrointestinal Investigation
  1. N Patel1,
  2. V J Blackwell1,
  3. P Patel1,
  4. M M Walker2,
  5. H R Williams1
  1. 1Gastroenterology & Hepatology, Imperial College London, London, UK
  2. 2Medicine & Public Health, University of Newcastle, Callaghan, Australia

Abstract

Introduction Duodenal biopsies are usually taken at upper gastrointestinal endoscopy to exclude coeliac disease (CD). To date, few studies have investigated overall duodenal pathologies in this group. Serological testing for anti-tissue transglutaminase antibodies (TTG) should be performed in patients with a diagnosis of lymphocytic duodenosis (LD), which may herald CD. The main objectives of this study were to determine the indications and histological findings for duodenal biopsies in a teaching hospital setting, and the prevalence of LD and new diagnoses of CD in this cohort.

Methods 1043 patients with duodenal biopsies taken during upper gastrointestinal endoscopy in a teaching hospital setting in 24 months (2009–11) were studied retrospectively. Demographics, indications and histological findings were documented. Patients with known CD were excluded from the study; if an individual had more than one biopsy in the time period then only the first biopsy was included. When a specific abnormality was targeted for biopsy this was recorded. For LD patients, TTG results were recorded where available.

Results The patients’ median age was 60 (range 16–97); 55% were female. Anaemia was the commonest indication for biopsy (in 51% of patients) followed by weight loss and abdominal pain.

76% of biopsies were normal. LD was found in 155 patients (15%), of whom 64% were female. Biopsy appearances of CD with positive TTG were found in 13 patients (1.2%). Documentation of serology was not always available and so the incidence of CD in this population may be underestimated. Crohn’s disease was diagnosed in 3 biopsies (0.29%). Graft versus host disease, drug effect, lymphangiectasia and infection were seen (1 Giardia, 1 atypical mycobacteria, 1 Strongyloides).

70 duodenal biopsies (7%) targeted specific abnormalities, including 6 malignancies (3 adenocarcinoma, 1 carcinoid tumour and 1 lymphoma) and 6 benign polyps including 2 adenomas. Of the 973 non-targeted biopsies, 772 (79%) were normal.

There were no statistical differences between positive biopsy results and specific indications.

Conclusion Whilst the majority of biopsies were normal, significant abnormalities were found in 24% and LD was present in 15%. While important for the diagnosis of CD, duodenal biopsy was also vital for the diagnosis other pathologies including infection, Crohn’s disease, drug effect and tumours.

Disclosure of Interest None Declared.

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