8 replies to this topic

[violentlyserene]

I got my lab results emailed to me today from my biopsy but I'm not quite sure what they mean. Clearly, there is damage but I'm wondering whether it confirms the drs guess of mild celiac based on my blood results of 83 on the ttg or whether the damage is more severe. Any thoughts?

FINAL DIAGNOSIS DUODENUM BIOPSY: FLATTENED MUCOSA WITH CHRONIC INFLAMMATION (SEE
MICROSCOPIC).

PATHOLOGIST: Mullen MD, Dennis L. Electronically Signed: 08/29/2011
SOURCE A) a. duodenum
PRE-OPERATIVE DIAGNOSIS celiac disease
GROSS APPEARANCE Received in a container labeled with the patient's name and "duodenum" are
0.3 and 0.4 cm soft tissue fragments, AE/(2).
MICROSCOPIC EXAMINATION This flattened mucosa includes only a few blunt villi. The lamina propria
shows a mixed inflammatory cell infiltrate. The differential diagnosis
includes celiac disease, peptic ulcer disease, and nonspecific duodenitis.

[Marilyn R]

I'm not a dr. or expert, but it sounds like the radiologist is saying that you have severe damage to you villi. He only found a few blunt villi on the specimens your GI took. The radiologist diagnosed you with celiac disease (not mild), and peptic ulcer disease, which will undoubtedly improve with a totally gluten-free diet. Thanks for posting, I'm going to ask my gastro for my radiologist report, even though it's been over a year since I had it.

The good news and bad news is that you have celiac disease. Wish you well and hope all of your first degree relatives get tested.

[violentlyserene]

I'm not a dr. or expert, but it sounds like the radiologist is saying that you have severe damage to you villi. He only found a few blunt villi on the specimens your GI took. The radiologist diagnosed you with celiac disease (not mild), and peptic ulcer disease, which will undoubtedly improve with a totally gluten-free diet. Thanks for posting, I'm going to ask my gastro for my radiologist report, even though it's been over a year since I had it.

The good news and bad news is that you have celiac disease. Wish you well and hope all of your first degree relatives get tested.

Thank you, that's extremely helpful. It sounded both like it was severe and also like it was mild in that the only damage was a few blunted villi so more experienced interpretations are helpful. I'm okay with having celiac (and honestly, I was kind of hoping for a very clear biopsy to avoid any ambivilence). Where do you get the peptic ulcer from?

[mushroom]

I don't know, Marilyn. The way I read it, it is a bit of a mixed bag. I looked up 'differential diagnosis' to confirm in my mind what it means:

Differential diagnosis: The process of weighing the probability of one disease versus that of other diseases possibly accounting for a patient's illness. The differential diagnosis of rhinitis (a runny nose) includes allergic rhinitis (hayfever), the abuse of nasal decongestants and, of course, the common cold.

So the differential diagnosis is weighing what disease process is actually causing the symptoms found. He talks about flattened mucosa; it's not clear if he's including the villi in the mucosa, and when he says ' only a few blunt villi', does he mean that's all he found or that's all that's left?? So I read that he is trying to determine which of the three caused the symptoms: The differential diagnosis includes celiac disease, peptic ulcer disease, and nonspecific duodenitis.

So is he meaning to diagnose all three conditions or differentiate between them? given that the final diagnosis is given as:


FINAL DIAGNOSIS DUODENUM BIOPSY: FLATTENED MUCOSA WITH CHRONIC INFLAMMATION

I am as confused as the poster.

[violentlyserene]

I asked a lab tech friend to take a look and she read it as saying there was severe damage. I'm leaning towards that as well because he first says the mucosa is flattened.

[Skylark]

I read it as saying mild damage. Inflammation, flattening, but only a few villi are blunted. Notice there is no crypting mentioned, which is the hallmark of severe celiac. Also, if the damage were severe, the pathologist would have firmly diagnosed celiac rather than saying it's possibly peptic ulcer disease or duodenitis.

I believe it confirms your doctors hunch of celiac disease that's not gotten too severe yet.

[mushroom]

Either way, it is a very poorly written report to create so much confusion

[Skylark]

Either way, it is a very poorly written report to create so much confusion

True. That fellow needed to take a couple English classes along with his pre-med.

[Sarah Alli]

It doesn't seem to complicated to me. It's been my experience that radiologists, pathologists, etc only report what they see, they don't diagnose. So...

FINAL DIAGNOSIS DUODENUM BIOPSY: FLATTENED MUCOSA WITH CHRONIC INFLAMMATION (SEE
MICROSCOPIC).

This is not a diagnosis in the normal sense. This is a description of the damage to your intestine.

PATHOLOGIST: Mullen MD, Dennis L. Electronically Signed: 08/29/2011
SOURCE A) a. duodenum

Seems straightforward. This was a duodenal endoscopy.

PRE-OPERATIVE DIAGNOSIS celiac disease

This is what your doctor suspected you had, your diagnosis before the endoscopy.

MICROSCOPIC EXAMINATION This flattened mucosa includes only a few blunt villi. The lamina propria
shows a mixed inflammatory cell infiltrate. The differential diagnosis
includes celiac disease, peptic ulcer disease, and nonspecific duodenitis.

This is the important part. As others have said, there's flattened mucosa but only a few blunted intestinal villi, etc. Then, the pathologist lists the diseases that can cause that damage.

Since you went for the endoscopy to confirm Celiac, and have results consistent with Celiac, this is almost certainly a positive result. You should call the doctor who sent you for the endoscopy to get his/her feedback and to make sure you've ruled out peptic ulcers as a causative agent.
It's sometimes easier to think of a result like this as not really designed for you to read. It's really intended for your doctor which is why it seems unclear. Call your doctor to discuss, and stop eating gluten if you haven't already.