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• W4234955420 abstract "We agree that the problem raised by Dr Matuchansky is potentially relevant. Several reports in the recent literature have emphasized the patchiness of the celiac lesion and the possibility that early lesions affect only the bulb, with the distal duodenum being normal. These data have been considered by European Society for Gastroenterology and Nutrition, and in the recently revised diagnostic criteria1Husby S. Koletzko S. Korponay Szabo I. et al.ESPGHAN guidelines for the diagnosis of celiac disease in children and adolescents: an evidence based approach.J Pediatr Gastroenterol Nutr. 2011 Aug; ([Epub ahead of print])Google Scholar a biopsy from the bulb is always requested. However, the difficulties in the interpretation of bulb findings must also be considered. Coming to our study, although we accept the theoretical risk of having missed some cases with atrophy by not taking biopsies from the bulb, we think that this risk is negligible. The 2 largest case groups (more than 600 cases each) report lesions limited to the bulb in 2.4% and in no case, respectively.2Bonamico M. Thanasi E. Mariani P. et al.Duodenal bulb biopsies in celiac disease: a multicenter study.J Pediatr Gastroenterol Nutr. 2008; 47: 618-622Crossref PubMed Scopus (98) Google Scholar, 3Ravelli A. Villanacci V. Monfredini C. et al.How patchy is patchy villous atrophy? Distribution pattern of histological lesions in the duodenum of children with coeliac disease.Am J Gatroenterol. 2010; 105: 2103-2110Crossref PubMed Scopus (103) Google Scholar It is unclear if the cases reported in the literature represent early presentation of the disease. With the opportunity to follow up our potential celiac disease cases, we hope to give an answer also to this question. In any case, we are very conscious of the risk of not treating osteopenia/osteoporosis in our patients with potential celiac disease. We routinely perform bone density studies in our patients and the finding, so far very rare, of osteopenia/osteoporosis renders the prescription of a gluten-free diet mandatory. Natural History of Potential Celiac DiseaseClinical Gastroenterology and HepatologyVol. 9Issue 12PreviewIn the April 2011 issue of the Journal, Tosco et al1 interestingly report that most of 106 children with so-called potential celiac disease (CD) (ie, with positive CD-associated antibodies but a normal duodenal mucosa architecture) remained healthy on a gluten-containing diet; after 2 and 3 years, respectively, only 23.1% and 33% of those who underwent a second and third biopsy developed villous atrophy. Full-Text PDF" @default.
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• W4234955420 date "2011-12-01" @default.
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