The diagnostic value of the duodenal biopsy: A clinico-pathologic analysis of 28,000 patients

Abstract 

Background

Duodenal biopsies are frequently obtained to investigate malabsorption, diarrhoea, and aneamia. The proportion of patients who have duodenal biopsies and their diagnostic yield are unclear.

Aims

To determine what proportion of patients undergoing esophagogastroduodenoscopy in a private setting has duodenal biopsies and to evaluate the diagnostic yield relative to clinical indications and endoscopic findings.

Methods

Records of patients who had duodenal biopsies diagnosed at a United States gastrointestinal pathology laboratory in a single year were analysed.

Results

28,210 patients with and 75,175 without duodenal biopsies were studied. Duodenal biopsy patients were younger (52 years versus 58 years, p<0.001) and more likely to be female (OR 1.46; p<0.0001); 87% of children and 27% of adults had duodenal biopsies. Suspicion of malabsorption or sprue, diarrhoea, aneamia, and weight loss were strong predictors of duodenal biopsy. More than 80% of patients had normal duodenum, except those biopsied for sprue, 64% of whom had normal findings. Marsh II–IIIc lesions were diagnosed in 23% of patients with suspected sprue, but in 3.0% of those with diarrhoea, weight loss, or aneamia, and in 1.5% of patients with dyspepsia or GERD.

Conclusions

A clinical suspicion of sprue produces the highest yield of histopathologic abnormalities; women are biopsied more often than men despite having less duodenal pathology.

Keywords: Celiac disease, Duodenal biopsy, Duodenum, Gender bias, Histopathology