Help Reading Pathology Report

[cacampora]

Hi everyone,

I had an endoscopy back in December. The gastroenterologist did not seem very knowledgeable about celiac disease and performed the endoscopy on me without checking if I had been eating gluten. I've learned a ton about celiac since my endoscopy and it seems like I should have been eating gluten for 2 weeks prior to the procedure. I had been eating gluten free at that point since October when my PCP tested my for endomysial antibody {my value was 1:640, range was <1:10} and TTG {my value was >100, range was 0-3}.

I am not a physican so medical speak is a different language to me, but does anyone know how to interpret my pathology report? When I met with the gastroenterologist to go over my results, he said I definitely have celiac disease. Here's what the report says:

Small intestine, small bowel, biopsy: duodenal mucosa with mild increase of intraepithelial lymphocytes.

Examination of levels show duodenal mucosa by the presence of scant Brunner's glands with preservation of the villous architecture. Mild increase of intraepithelial lymphocytes is noted. No widening of villi, crypt hyperplasia, acute inflammatory cells, gastric surface metaplasia or Giardia is noted.

The gastro also had me do celiac blood panel. I did my research on that and did a gluten challenge for 7 weeks. Here are those blood results:

TTG {my value was >250 H, range was <15}

Endomysial antibody SCR (IGA): positive

Endomysial antibody titer {my value was 1:160 H, range was <1:5 titer}

I've now had blood work done twice now that is consistent. I am due to see a new gastroenterologist next month and I'll be sure to bring all my results to that appt. I have no idea what the pathology report means, but the results may be confusing since I was gluten free at that point.

Thanks!

[Scott Adams]

Based on your extremely high tTG results alone, most doctors in Europe would now diagnose you with celiac disease without an endoscopy/biopsy. What that level means is that you probably had severe flattening of the villi which hadn't fully healed, even though you were gluten-free for weeks or a few months before the endoscopy, there was still damage. 

Another possibility is that your diet hasn't been 100% gluten-free, and this can be true, for example, if you eat in restaurants, as they are a common source of cross-contamination. This article may be helpful in that regard:

 

[cacampora]

18 hours ago, Scott Adams said:

Based on your extremely high tTG results alone, most doctors in Europe would now diagnose you with celiac disease without an endoscopy/biopsy. What that level means is that you probably had severe flattening of the villi which hadn't fully healed, even though you were gluten-free for weeks or a few months before the endoscopy, there was still damage. 

Another possibility is that your diet hasn't been 100% gluten-free, and this can be true, for example, if you eat in restaurants, as they are a common source of cross-contamination. This article may be helpful in that regard:

 

Thanks for your reply!

How would you interpret the histology report? My GI hasn't been the best to work with and doesn't respond to any questions/messages I have. I'm looking forward to seeing a new GI next month. My current GI never explained the histology report to me, just said I have celiac. 

Thanks!

[RMJ]

The extremely simplified explanation of the biopsy: the only abnormal finding was a mild increase in a type of white blood cells within the layer of cells lining the first part of the small intestine.

Hope that helps!

This abnormality is typically seen in celiac disease.  It is a bit unusual that this is the only thing that was seen, especially with your high antibody levels.