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How Important Is The Biopsy?


kaysol

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kaysol Rookie

I am FINALLY meeting with a GI Dr. on Tues after waiting over a month to get in.

all 3 of my blood tests came back positive for celiac. My meeting Tuesday is just a consultation - they wouldnt even let me schedule the biopsy until I meet with him. I am so worried that it might take another month to get the biopsy done and I am getting sicker by the day. The past 3 weeks have been terrible, my stomach keeps gettting bigger and bigger (I actually look pregnant), I go between terrible consipation and then to diarehha and wake up at night with horrible pains in lower intestines. I guess my question is, if they can't get me in any time soon should I just say forget the biopsy and go with the blood test diagnosis? Could anything else make the the labs posative other than celiac? I am hating that I have to eat gluten and knowing that I could feel so much better. I feel like my life is on hold and I am so scared that something else could be wrong due to the disstention and horrible pains. My numbers on the blood work were all very high (IGA was 144 and my IGG was 111 and the other one was positive although I don't know the #'s also my cholesteral and iron were very low - 150 and 8). I am trying to prepare myself for the possibility that I might be told I have to eat gluten for another month or longer and I am wondereing if I would be safe saying forget it. Can these numbers mean anything else? I am so depressed and scared right now. I didnt really have many syptoms until recently but I feel like I keep gettting sicker by the day. Any advice would be much appreciated!

Thanks!

Stephanie


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Guest jhmom

Hi Stephanie, I am sorry you feel bad and are still going through the diagnosis process. It can be hard to make decisions about our health especially when we feel bad and just want to feel better. We trust our doctors and what they recommend but if it were me and my blood tests came back positive I would not go through with the biopsy, I would immediately begin the gluten-free diet. One thing to think about is sometimes blood test can be positive and biopsies can be negative and vice versa, so just keep that in mind.

Feel better soon :rolleyes: Take care

tarnalberry Community Regular

It's a personal decision. I am not biopsy diagnosed, but my doctor was willing to go on inconclusive blood tests and positive dietary challenge. But it's really a personal decision. You might have very little intestinal damage (though I'd doubt it from the low iron count), but at the least the blood tests say your immune system reacts to gluten.

SteveW Rookie

Going through the diagnosis process is not fun. It took me around 3 1/2 months of hell before I was confirmed to have Celiac Disease. But I also had a colonoscopy and was told I had some irritation in my colon and that I might have Crohns as well as Celiac. Turns out that I do have a mild case of Crohns. So I guess I'm saying in my case it was worth to get the biopsy. If you choose to go with a biopsy make sure that you get a colonoscopy at the same time. All these intestinal disorders have similar symptoms so the best way is to go in and check them all out.

CarolynM Newbie

Weighing in on the "skip the biopsy" side! With only positive antigliadin, we reluctantly went with the doc's recommendation and did the biopsy. ( I was ready to try gluten-free seeing obvious reactions to pastas, pancakes) It postponed getting by daughter healthy by nearly 3 months.

After waiting for an appointment then the biopsy. We were told everything was completely within normal range after the biopsy. She got worse and I decided to go gluten-free without the doc. It took only 3 days to see improvement - solid stools and sleeping much better. Now a month later, I wish I had skipped the anxiety of the biopsy and the $6000+, and still coming, in medical bills that thankfully, our insurance is paying 80%.

I say try your own test with a gluten-free diet. You can always go back to the doc for tests if you don't improve.

ryeanddiet Rookie

Hi Stephanie

I'd vote for 'get the diagnosis'. Several on the board have gotten relatively quick tests from enterolab and had the results accepted by their GI/GP, if your Dr won't confirm the diagnosis just with the blood test, ask if he/she would accept this.

I don't have that option living in Canada. I had positive blood so went gluten-free only (I felt better than I ever have in my life, all symptoms disappeared, all anemias turned around) to have the GI tell me 8 months later they wouldn't confirm celiac without the biopsy. I want the formal, medical diagnosis so Dr's will keep an eye out for associated illness, my children will get tested, etc.

I'm now back on gluten in preparation for the biopsy and am more sick than I was before. I know it's not fun but my opinion would be to get the diagnosis (unless you don't care and it's unbareable, in which case try to find a more sympathetic Dr and go gluten-free).

If your GI insists on a scope, there may be options. I'm paying to go to a higher end private clinic just so I don't have to wait the 9 months for the appt (I'm in Canada, public health care takes longer).

Best of luck. Fingers crossed.

jen

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    • cristiana
      Hi @CC90 Ah... that is very interesting.  Although it is very annoying for you to have to go through it all again, I would say that almost sounds like an admission that they didn't look far enough last time?   I could be wrong, but I would not be at all surprised if they find something on the next attempt.  Coeliac damage can be very patchy, as I understand it, so that's why my own gastroenterologist always likes to point out that he's taken lots of samples!  In the kindest possible way (you don't want to upset the person doing the procedure!) I'd be inclined to tell them what happened last time and to ask them in person to take samples lower down, as  if your health system is anything like the one in my country, communication between GPs, consultants and hospitals isn't always very good.  You don't want the same mistake to be made again. You say that your first endoscopy was traumatic?  May I ask, looking at your spelling of coeliac, was this done at an NHS hospital in England?  The reason for the question is that one of my NHS diagnosed friends was not automatically offered a sedative and managed without one.  Inspired by her, I tried to have an endoscopy one time, in a private setting, without one, so that I could recover quicker, but I had to request sedative in the end it was so uncomfortable.    I am sorry that you will have to go through a gluten challenge again but to make things easier, ensure you eat things containing gluten that you will miss should you have to go gluten free one day. 😂 I was told to eat 2 slices of normal wholemeal bread or the equivalent every day in the weeks before , but I also opted for Weetabix and dozens of Penguin chocolate biscuits.  (I had a very tight headache across my temple for days before the procedure, which I thought was interesting as I had that frequently growing up. - must have been a coeliac symptom!)  Anyway, I do hope you soon get the answers you are looking for and do keep us posted. Cristiana  
    • CC90
      Hi Cristiana   Yes I've had the biopsy results showing normal villi and intestinal mucosa.  The repeat endoscopy (requested by the gastro doc) would be to take samples from further into the intestine than the previous endoscopy reached.      
    • Wheatwacked
      Transglutaminase IgA is the gold-standard blood test for celiac disease. Sensitivity of over 90% and specificity of 95–99%. It rarely produces false positives.  An elevated level means your immune system is reacting to gluten.  Non-Celiac Gluten Sensitivity (NCGS) does not typically cause high levels of tTG-IgA. Unfortunately the protocols for a diagnosis of Celiac Disease are aimed at proving you don't have it, leaving you twisting in the wind. Genetic testing and improvement on a trial gluten free diet, also avoiding milk protein, will likely show improvement in short order if it is Celiac; but will that satisfy the medical system for a diagnosis? If you do end up scheduling a repeat endoscopy, be sure to eat up to 10 grams of gluten for 8 - 12 weeks.  You want  to create maximum damage. Not a medical opinion, but my vote is yes.
    • trents
      Cristiana asks a very relevant question. What looks normal to the naked eye may not look normal under the microscope.
    • cristiana
      Hello @CC90 Can I just ask a question: have you actually been told that your biopsy were normal, or just that your stomach, duodenum and small intestine looked normal? The reason I ask is that when I had my endoscopy, I was told everything looked normal.  My TTG score was completely through the roof at the time, greater than 100 which was then the cut off max. for my local lab.  Yet when my biopsy results came back, I was told I was stage 3 on the Marsh scale.  I've come across the same thing with at least one other person on this forum who was told everything looked normal, but the report was not talking about the actual biopsy samples, which had to be looked at through a microscope and came back abnormal.
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