Determining its celiac disease through biopsy

[Gini1]

Hi,

I recently received my endoscopy biopsy results, indicating a "Small bowel mucosa with mild increase in intraepithelial lymphocytes, cannot rule out f celiac disease" was mentioned. Subsequently, my doctor recommended blood tests, with both the IgA serum test and the Tissue Transglutaminase IgA Abs report returning normal results.

However, there seems to be a difference in opinion between my Gastroenterologist and primary care doctor. The former leans towards a celiac disease diagnosis based on the biopsy results, while the latter is skeptical due to the normalcy of the blood tests.

I am seeking guidance on the next steps to confirm or rule out celiac disease definitively. Can you provide insight into whether the biopsy report, indicating a small bowel mucosa with a mild increase in intraepithelial lymphocytes, is sufficient for a conclusive diagnosis of celiac disease?

Your expertise and advice on how to proceed would be greatly appreciated. Thank you for your time and assistance.

[knitty kitty]

Welcome to the forum, @Gini1!

You can take a DNA test to see if you have any of the known genes for Celiac Disease.  

Anemia, diabetes, and thiamine deficiency can cause false negatives on serum tests.  Seronegative Celiac Disease does exist, where people with Celiac Disease don't show anti gluten antibodies in their blood.  

Other blood tests include the DGP IgA and IgG and the EMA IgA, but these depend on you having to eat a lot of gluten for several months  to get them to show up.  

The amount of gluten that you were eating prior to your "normal" tTg IgA test result could have caused the false negative.  Some people try a gluten free diet before going to their doctor.  About ten grams of gluten a day is needed to produce antibodies and villous damage.

Hope this helps!

[trents]

Like knitty kitty, I also wonder if you were restricting gluten intake before the antibody blood tests. 

[Gini1]

5 hours ago, Gini1 said:

Hi,

I recently received my endoscopy biopsy results, indicating a "Small bowel mucosa with mild increase in intraepithelial lymphocytes, cannot rule out f celiac disease" was mentioned. Subsequently, my doctor recommended blood tests, with both the IgA serum test and the Tissue Transglutaminase IgA Abs report returning normal results.

However, there seems to be a difference in opinion between my Gastroenterologist and primary care doctor. The former leans towards a celiac disease diagnosis based on the biopsy results, while the latter is skeptical due to the normalcy of the blood tests.

I am seeking guidance on the next steps to confirm or rule out celiac disease definitively. Can you provide insight into whether the biopsy report, indicating a small bowel mucosa with a mild increase in intraepithelial lymphocytes, is sufficient for a conclusive diagnosis of celiac disease?

Your expertise and advice on how to proceed would be greatly appreciated. Thank you for your time and assistance.

 

Thank you very much. I remember eating bread on Wednesday and getting the blood work on the following monday.   

[Gini1]

Since I only got diagnosed with celiac in my adulthood I am wondering if I eat in a restaurant and there are all kinds of food with gluten there but I chose gluten-free dishes only would that be ok 

[trents]

Gini1, It takes at least 6 weeks of consuming say, the gluten equivalent of 6 slices of wheat flour bread daily to be confident of creating enough inflammatory antibodies to give valid testing. Eating a bunch of gluten containing food the day before isn't going to cut it. It takes a while for the antibody count to build up in the blood to a sufficient level to be detected by the tests.

"Gluten free" offerings in restaurants are usually not truly gluten free because of cross contamination. Typically, they are cooked on the same surfaces as gluten stuff and stirred, handled, sliced, etc. with the same utensils as gluten containing foods. In reality, they are lower gluten. I'm a little confused by your question. What are you thinking when you say, "Since I only got diagnosed with celiac in my adulthood . . ." . In your mind, what difference do you think that would make? And are you making the assumption that the diagnosis came soon after the onset of the disease? Most of us develop it years in advance of diagnosis. It often takes about 10 years to get an accurate diagnosis.

 

[Scott Adams]

12 hours ago, Gini1 said:

 

Thank you very much. I remember eating bread on Wednesday and getting the blood work on the following monday.   

Here is more info about how to do a gluten challenge for a celiac disease blood panel, or for an endoscopy:

Quote

"...in order to properly diagnose celiac disease based on serology and duodenal histology, doctors need patients to be on gluten-containing diets, even if they are causing symptoms, and this is called a "gluten challenge."

• Eat gluten prior to celiac disease blood tests: The amount and length of time can vary, but is somewhere between 2 slices of wheat bread daily for 6-8 weeks and 1/2 slice of wheat bread or 1 wheat cracker for 12 weeks 12 weeks;
• Eat gluten prior to the endoscopic biopsy procedure: 2 slices of wheat bread daily for at least 2 weeks;

and this recent study recommends 4-6 slices of wheat bread per day:

 

 

[Gini1]

Very informative thank you

[Gini1]

Trents thank you. Sorry for not being clear with my question, I meant is gluten contamination going to harm my condition? If yes, how do people manage eating when they have celiac.