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An approach to duodenal biopsies
  1. S Serra,
  2. P A Jani
  1. Department of Pathology, University Health Network and Toronto Medical Laboratories, Toronto, Ontario, Canada
  1. Correspondence to:
    S Serra
    Department of Pathology, University Health Network and Toronto Medical Laboratories, 200 Elizabeth Street, 11th Floor, Toronto, Ontario, M5G 2C4, Canada;stefano.serra{at}


The introduction of endoscopy of the upper digestive tract as a routine diagnostic procedure has increased the number of duodenal biopsy specimens. Consequently, the pathologist is often asked to evaluate them. In this review, a practical approach to the evaluation of a duodenal biopsy specimen is discussed. An overview of the handling of specimens is given and the normal histology and commonly encountered diseases are discussed. Finally, a description of commonly seen infections is provided, together with an algorithmic approach for diagnosis.

  • CMSE, cow’s milk protein-sensitive enteropathy
  • CMV, cytomegalovirus
  • DGM, duodenal gastric metaplasia
  • DPAS, diastase periodic acid Schiff
  • EMA, endomysial antibodies
  • EITCL, enteropathy-type intestinal T cell lymphoma
  • GFD, gluten-free diet
  • GSE, gluten-sensitive enteropathy
  • H&E, haematoxylin–eosin
  • IEL, intraepithelial lymphocyte
  • IPSID, immunoproliferative small intestinal disease
  • NSAID, non-steroidal anti-inflammatory drug
  • PAS, periodic acid Schiff
  • V:C ratio, villous to crypt ratio
  • TCR, T cell receptor
  • tTGA, transglutaminase antibody

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  • Published Online First 10 May 2006

  • Competing interests: None declared.