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Why Is A Biopsy So Often Necessary When Labs Are Positive?

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I'm just awaiting my lab results and have been wondering - why is it so often recommended to go get a biopsy if the bloodwork comes back positive?  Especially if it's really positive.  I know the biopsy is the 'gold standard", and I understand the importance of doing it if there are symptoms and the bloodwork is negative because there can still be damage, but I don't understand the justification when the bloodwork is positive.  


Isn't the bloodwork (at least one of the tests) pretty specific to celiac?  If you're making antibodies to gliadin, isn't that a big red flag that something is wrong and you should be avoiding gluten anyway?


There's obviously something that I'm not understanding fully.  What justifies a more invasive procedure such as a biopsy when the bloodwork seems to tell us that the answer is to avoid gluten no matter what?


ps - I am aware of the somewhat newer guidelines that allows a doctor to diagnose celiac without biopsy in certain circumstances, based on bloodwork.  Just wondering why this isn't always the case.

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Here's a link from the University of Chicago's Celiac website that can answer your question:




That said, I had a "mild" positive on my blood test.  Seven weeks later my biopsy (they took more than two samples) showed Marsh Stage IIIB damage.  Now, I know exactly where I stand.  I'll have a follow-up blood test and another biopsy in a year.  Hopefully, the damage to my intestines will improve.  If I'm gluten free compliant (via blood test) and I'm still stuck at Marsh Stage IIIB,  maybe I'm getting damage from something else.  At least I have something to compare it to (that's not the wording that I'm looking for.....)


Some people just use the blood test since having an endoscopy in itself may be risky due to other medical problems.  They then  try the diet to see if it relieves symptoms.   Later, they may have to have an endoscopy if their symptoms don't improve.


Does that help?  

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