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Suppose the biopsy or serum tests are inconclusive. What do you do?**

Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: The biopsy may be inconclusive. Serum, if tested for gliadin, endomysial and reticulin antibodies, should provide unequivocal information. Ours and other studies have provided a strong reliability of the serum tests.

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Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: The biopsy may be inconclusive in a small percentage of patients with so-called patchy lesions in the duodenum. It means that there are histologically normal looking spots with finger like villi and pathologic spots showing flattened mucosa in the upper half of the duodenum. If celiac disease is suspected, the gastroenterologist should obtain several biopsies from different spots of the whole duodenum. Most of the endoscopists routinely examine only the upper half of the duodenum (duodenal bulb and the descending part). The transverse segment of the duodenum is not viewed routinely. Few endoscopic centers have an enteroscope, which is a longer and more flexible endoscope for examining the entire duodenum and jejunum. The enteroscopy allows you to obtain biopsies even from the jejunum. The histological examination of a single biopsy specimen may increases the risk of false negative diagnosis.

The experience of the pathologist in the interpretation of small intestinal histology is important. In centers specializing in celiac disease the gastroenterologist routinely reviews the histologic slides together with the pathologist. There is still a possibility of inconclusive results if multiple biopsies are obtained and the histological interpretation is appropriate. All disease has a developmental process. It means that it takes time for the pathological changes to be evident. There are cases when the symptoms suggest CD, however, the histology is not conclusive. This problem occurs in only a few cases. A repeated biopsy may be necessary after a period of higher gluten intake. However, if the antiendomysium antibody test is positive and the histology is not conclusive a gluten-free diet is recommended.

The serology test may be inconclusive if:

  • The sample handling and shipping is inappropriate; e.g. the serum was shipped at room temperature for days
  • The patient has IgA deficiency, which occurs in one out of 600 people in the general population and much more frequently in patients with CD. In these cases the antigliadin IgA and the antiendomysium IgA tests give negative results. If the tests are performed in a laboratory specialized in celiac serological tests, the laboratory recommends a test for immunoglobulins. If a patient has IgA deficiency and positive antigliadin IgG test, he/she should undergo further absorptive tests and/or an intestinal biopsy.

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I'm a naturalist -- I don't use drugs, creams, etc. I do, however, scratch** the rash until I'm almost bleeding and then dump isopropyl alcohol in it -- that relieves the itch for quite some time. (Stings at first though.) I get the rashes on my legs. ANYWAY, I have found that a gluten-free diet is the only (or best) approach -- it's certainly the most natural, in my opinion. It took six months before I felt I was cleansed of gluten. I went nine months (or more) without a rash. Then, I mistakenly ate some soup with barley in it. Got the rash. I let it run its course while getting back to & staying on a gluten-free diet. My best advice is just to stay on a gluten-free diet. Be strong, brave. You can do it! ** I should clarify that when my rashes start itching, I can't help but scratch (excessively). I am not suggesting scratching yourself (with or without cause) as a means to an end. Don't scratch if you can.

Nicotinamide helps a great deal. Nicotinamide is a form of Vitamin B3, also called Niacin. Many new Celiacs have trouble absorbing sufficient vitamins and minerals because of intestinal damage. Malabsorption causes malnutrition. Deficiencies of the B Complex vitamins, especially niacin, and vitamins A and D often manifest as skin rashes and exacerbate DH. Recent research has found that treatment with nicotinamide and tetracycline effectively treats DH. Ask your doctor to check for vitamin deficiencies if you haven't already. Also dapsone use may cause iron, B12, and folate deficiencies which may lead to anemia. These should be monitored as well. Hope this helps.

I'm so excited! The Austin area has a new gluten-free restaurant - Guaco Taco. I'm going there tomorrow night for dinner. I love Mexican food and miss being able to eat it out.

I see the original post, and most replies, are old, but I thought I would weigh in as a vegetarian... for almost 25 years now. I wish you all good health!

Hmmm, interesting. That's a good policy!