Tag Archives: dudoenal bulb

Celiac Disease: Lower TTG-IgA Titers Associated with Isolated Duodenal Bulb Presentation

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QY Wang et al. JPGN 2025; 80:678–685. Open Access! Low TTG-IgA associated with isolated bulb pathology in pediatric celiac disease: Implications in a no-biopsy approach era

Methods: There were 405 cases included in this retrospective study (mean age = 9.6 years). TTG-IgA values were considered negative if <4 U/mL, equivocal between 4 and 10 U/mL inclusively, and positive if >10 U/mL. At the authors’ institution, TTG‐IgA ≥10× ULN corresponds to ≥100 U/mL.

Key findings:

  • Bulb-restricted CD was present in 7.4% of cases
  • TTG-IgA was negative or equivocal in 60.0% of bulb-restricted CD, compared to 5.3% of distal duodenal CD (odds ratio [OR] = 26.6
  • No bulb-restricted CD cases attained TTG-IgA ≥10× ULN, compared to 48.5% of distal duodenal CD

My take: This study confirms and quantitates what most clinicians have experienced. Isolated duodenal bulb pathology is associated with lower celiac titer abnormalities.

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Gorgeous stained glass by Margaret Vetter at Piedmont Arts Festival