Jump to content
  • Sign Up
  • Join Our Community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Diana Gitig Ph.D.
    Diana Gitig Ph.D.

    Adherence to Biopsy Guidelines Increases Celiac Disease Diagnosis

    Celiac.com 06/15/2011 - A duodenal biopsy during endoscopy is the gold standard for diagnosing celiac disease. Because the histopathological features suggesting celiac disease , specifically villous atrophy, can vary in severity throughout the length of the small intestines, the American Gastroenterological Association Institute recommended in 2006 that at least 4 specimens be taken for examination. Yet the degree of adherence to this recommendation has not been assessed, and neither has its impact on diagnoses. A recent study by Benjamin Lebwohl at the Columbia University Celiac Disease Center concludes that most physicians are not following the guidelines, but they should be; doing so doubles the diagnosis of celiac disease.

    Dr. Lebwohl and colleagues collated the specimens sent to Caris Life Sciences, a specialized GI pathology laboratory that receives samples from endoscopy centers in forty-three states plus the District of Columbia and Puerto Rico. They looked at 132, 352 patients who had endoscopies for various indications between January 1, 2006 and December 31, 2009. From these endoscopies, only 35% followed the recommendation of submitting at least four specimens. There was a slight increase once the guidelines were proposed, in 2006; but by the end of 2009 adherence to the guidelines was still a low 37%. Interestingly, the number of specimens submitted could be directly correlated with the probability of a positive diagnosis of celiac disease.

    Adherence varied by indication, with the highest rates (43.9%) among patients undergoing endoscopies for diarrhea and the lowest rates (30.0%) among those having endoscopies because of heartburn. Among patients having endoscopies for malabsorption or suspected celiac disease adherence was only 38.5%. Adherence to the guidelines also decreased with the age of the patient. The researchers did not have access to socioeconomic or racial data regarding the patients, so could not determine if that factored into adhering to the guidelines.

    The proportion of patients diagnosed with celiac doubled when at least four biopsy specimens were submitted. This increase varied by indication; it was most apparent in those undergoing endoscopy because of malabsorption and suspected celiac disease, but was present for the other indications as well. This study validates those recommendations; hopefully the slight increase in adherence since they have been proposed will continue to grow.

    Source:



    User Feedback

    Recommended Comments

    Where is the logic to adhere to this recommendation? Endoscopy after a positive blood test, and especially after relief of symptoms with dietary modifications, smacks of creating reasons to get paid. Endoscopies are time consuming and painful. Why do unnecessary harm to the patient?! If there are antibodies, that means the Lyphocytes are primed to attack. Villous atrophy will occur, whether it has or not already. I for one WILL NOT put my 6 year old thru this painful procedure only to confirm what we already know!

    Share this comment


    Link to comment
    Share on other sites

    I just got diagnosed with celiac in March of this year, and for one I am relieved to finally have a name to what I have. The Endoscopy and biopsy that they did on my small intestine was not painful at all and I wouldn't even know that they had done anything at all!! Thanks to celiac.com I'm getting lots of information, and It's helped me out a million! Thanks.

    Share this comment


    Link to comment
    Share on other sites
    Guest iwantmybrainback

    Posted

    Where is the logic to adhere to this recommendation? Endoscopy after a positive blood test, and especially after relief of symptoms with dietary modifications, smacks of creating reasons to get paid. Endoscopies are time consuming and painful. Why do unnecessary harm to the patient?! If there are antibodies, that means the Lyphocytes are primed to attack. Villous atrophy will occur, whether it has or not already. I for one WILL NOT put my 6 year old thru this painful procedure only to confirm what we already know!

    This is in response to Celiac Mom. As an Certified Peri- operative Nurse and a celiac patient, I have never observed nor felt any pain or discomfort either operatively or post-op endoscopy. In my experience, the average time spent in an out-patient setting is 1 hour prior and 1/2 hour in recovery room. The actual procedure is usually less than 15 minutes. I surely would want to rule out everything else prior to committing my child to a life time of such a restrictive diet.

    Share this comment


    Link to comment
    Share on other sites
    Where is the logic to adhere to this recommendation? Endoscopy after a positive blood test, and especially after relief of symptoms with dietary modifications, smacks of creating reasons to get paid. Endoscopies are time consuming and painful. Why do unnecessary harm to the patient?! If there are antibodies, that means the Lyphocytes are primed to attack. Villous atrophy will occur, whether it has or not already. I for one WILL NOT put my 6 year old thru this painful procedure only to confirm what we already know!

    Right on Celiac Mom! I was very fortunate when I was diagnosed. The blood screen came back positive. The doctor said we could do a biopsy, but, seeing as I already had a lot of inflammation, she personally didn't see the point in adding to it with a biopsy. "If you strictly follow the diet for four months, you'll know whether you improve or not." And she was right. This article just shows what a crock it is that endoscopies are considered the "gold standard" of diagnosis. The diagnostic protocol is spelled out by gastroenterologists. And they certainly aren't going to declare that one of their most profitable procedures isn't necessary. It's worth noting that the doctor I saw wasn't a gastroenterologist and her income didn't depend upon endoscopies.

    Share this comment


    Link to comment
    Share on other sites
    This is in response to Celiac Mom. As an Certified Peri- operative Nurse and a celiac patient, I have never observed nor felt any pain or discomfort either operatively or post-op endoscopy. In my experience, the average time spent in an out-patient setting is 1 hour prior and 1/2 hour in recovery room. The actual procedure is usually less than 15 minutes. I surely would want to rule out everything else prior to committing my child to a life time of such a restrictive diet.

    I just spent two months recovering from a severe hemorrhage and almost went into shock caused by a duodenal biopsy during a simple endoscopy! It was done with the intention to diagnose celiac disease. A simple, everyday test STILL can cause ill effects.

    Share this comment


    Link to comment
    Share on other sites

    I tested positive on my blood test over a month ago. I saw the GI today and found out that I have to get an endoscopy and colonoscopy. The thing that worries me is that I was told to add gluten to my diet 2 weeks before endoscopy and biopsy. I had been doing really well on gluten-free diet but how am I going to handle the effects of eating gluten? I don't want to be calling in to work. I know I have to take day off for tests.

    Share this comment


    Link to comment
    Share on other sites
    Where is the logic to adhere to this recommendation? Endoscopy after a positive blood test, and especially after relief of symptoms with dietary modifications, smacks of creating reasons to get paid. Endoscopies are time consuming and painful. Why do unnecessary harm to the patient?! If there are antibodies, that means the Lyphocytes are primed to attack. Villous atrophy will occur, whether it has or not already. I for one WILL NOT put my 6 year old thru this painful procedure only to confirm what we already know!

    Biopsy to confirm a blood test are not 100%. If the child is correctly diagnozed then it is necessary to determine if family members are affected by this disease.

    Share this comment


    Link to comment
    Share on other sites


    Join the conversation

    You can post now and register later. If you have an account, sign in now to post with your account.
    Note: Your post will require moderator approval before it will be visible.

    Guest
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • About Me

    Diana received her B.A. in Biochemistry from the University of Pennsylvania, and then a Ph.D. in Cell Biology and Genetics from Cornell. Now she is a freelance science writer and editor in White Plains, New York.  Her son was diagnosed with celiac disease in 2006, at the age of five, and she has been keeping her family healthy by feeding them gluten free treats ever since.

  • Related Articles

    Scott Adams
    Pediatrics 2005;115:1341-1346.
    Celiac.com 05/31/2005 – According to Canadian researchers, the use of Tissue Transglutaminase Antibody (tTG) Screening may soon replace the use of the small bowel biopsy to diagnose celiac disease in children. The researchers reviewed the charts of 103 children who were screened for celiac disease using both small bowel biopsy and tTG. Fifty-eight of the children were found to have positive biopsy results, and out of these, 48 had very high tTG levels (over 100 U), 7 had middle tTG levels (20-100 U), and 3 had low levels (less than 20 U). Out of the 49 children with the highest tTG levels, all but one of them had a positive biopsy result. There were 3 biopsy-positive children who had low tTG levels, two who were found to be IgA negative, and one who had a duodenal ulcer.
    According to the researchers, using tTG values of greater than 100 U and less than 20 U, and knowing the patients IgA status, tTG testing was "98% sensitive and 97% specific in detecting celiac disease." The researchers also point out that the cost of diagnosis could be cut by 30% by utilizing tTG screening. The researchers conclude that children with high tTG titers can proceed straight to a gluten-free diet--if they respond well then their diagnosis is confirmed—if not they can proceed to a biopsy.
    Although the authors dont address this issue specifically, this method would likely lead to an increase in the diagnosis rate of celiac disease, as many people are unwilling to undergo a biopsy--or have their children undergo one.

    Jefferson Adams
    Celiac.com 05/21/2012 - A trio of researchers recently compared duodenal and jejunal small intestinal biopsies for diagnosis and follow-up of celiac disease. The researchers included J.W. Meijer, P.J. Wahab, and C.J. Mulder from the Department of Pathology, Rijnstate Hospital Arnhem, The Netherlands.
    Current pediatric guidelines advise doctors to take intestinal mucosal specimens from the jejunum using a suction capsule.
    This method can be stressful for patients, time-consuming, expensive and requires the use of imaging technology.
    Taking mucosal biopsies from the distal duodenum using forceps is less stressful for patients, easier, cheaper and can be done using an endoscope.
    For those reasons, the researchers wanted to compare the histological results of biopsies taken from the duodenal mucosa by forceps and from the jejunal mucosa using suction capsule.
    To do so, they evaluated 171 paired biopsies taken from 109 patients from 1 to 75 years of age. Biopsies were made from the distal duodenal mucosa using jumbo forceps and from the jejunal mucosa using Crosby suction capsule.
    For histological interpretation they applied modified Marsh classification, including partial-, subtotal and total villous atrophy as Marsh IIIA, B, and C.
    A total of fourteen (8%) of the suction capsule biopsies were too low quality to be properly scored, while all duodenal biopsies taken with forceps produced adequate material for histological scoring.
    Of the remaining biopsies, a total of 145 of 157 (92%) showed no difference in histological scores.
    The remaining 12 biopsies showed some discrepancy in scoring, four of those showed more severe lesions in the duodenum, while eight showed more severe lesions in the jejunum.
    The differences were clinically significant, and included the presence and absence of villous atrophy in nine of the 157 paired biopsies (6%).
    The results showed that mucosal specimens taken from the distal duodenal and jejunal mucosa are strongly correlated, with clinically significant discrepancies were present in only 6% of paired biopsies.
    Based on these results, the researchers suggest that diagnosis and follow-up of celiac disease can be done using mucosal specimens taken from the duodenum using forceps, rather than the traditional biopsy of the jejeunum using Crosby suction capsule.
    Source:
    Virchows Arch. 2003 Feb;442(2):124-8. Epub 2002 Dec 20.

  • Popular Contributors

  • Forum Discussions

    For making oven-roasted pototoes, I cannot recommend highly enough using chicken fat, duck fat or goose fat, for those who can find or have access to these fats.  Not only are they significantly unsaturated, being almost liquid at room temperature (unlike say lard), they are surprisingly light in texture and "feel", and overall quite healthy.  I carefully skim off and save ALL the rendered fat when I make chicken soup from organic chickens, to use in later dishes. Another perfect fat for th
    Oh yes, that does sound good!  I've always been fine with potatoes, but just haven't eaten them all that frequently, and usually in a recipe that specifically needed or called for them.  But for the next few months, at least, I think I'll be using them much more. Not that I want to try to subsist mostly on carbs here, but I am also going to be using more sweet pototoes, and also trying to incorporate both plantains (cooking bananas) and yuca (cassava root) into my diet as well.  Both of the
    Have you ever considered an air fryer. We bake like cycling lady or use air fryer. To crisp them for air fryer after slicing one can soak them a bit in water then pay dry before air fry helps crisp them. Good luck no matter what you find. I try to stay with one type of oil as mixed vegetable oil they often use corn which I also can't have.  
×
×
  • Create New...