Biopsy results - second opinion?

[ellyelly]

Hi all,

Such valuable insights shared here - I am so grateful to be able to read along! Thank you all for sharing your wisdom. 

I (37yo female) have recently had an endoscopy to screen for celiac given a strong family history and extremely low Ferritin for the past 7 years (not responsive to oral supplements). I am awaiting celiac blood panel results (completed post-endoscopy to provide another piece of the puzzle, I think was just an accidental oversight not doing earlier). 

The endoscopy results are as follows:

Gastroscopy: 

Stomach: Mild gastritis and one 4mm benign appearing inflammatory polyp in the body. 

Duodenum: Largely normal but few shallow erosions seen in the duodenal bulb.

Microscopy: 

1. Sections show specialised and non-specialised gastric mucosa with increased numbers of chronic inflammatory cells within the lamina propria including occasional clusters of plasma cells amounting to mild chronic inflammation. No active inflammation, intestinal metaplasia, dysplasia or malignancy is seen. Immunostains for Helicobacter organisms are negative.

2. Sections show small bowel mucosa with normal villous architecture. A mild non-specific intra-epithelial lymphocytosis is noted at the villous tips of uncertain clinical significance. The lamina propria contains a normal population of chronic inflammatory cells. No granulomas or parasites are seen. There is no dysplasia or malignancy.

Conclusion

1. Gastric: Mild chronic inflammation

2. Duodemum: Mild non-specific intraepithelial lymphocytosis with preserved villous architecture. 

The GI specialist, assuming blood tests come back normal, feels it is unlikely that it is celiac given the normal villous architecture. Suggested continuing on as usual and monitoring for symptoms etc, screening with blood test if required in the future. 

Worth a second opinion or does this seem accurate? Anything else I should be considering?

I feel a little lost as to how to best proceed!

Thanks again.

 

[knitty kitty]

Welcome to the forum, @ellyelly!

How much gluten were you eating in the weeks prior to the endoscopy?  Many people with indeterminate results had cut down or eliminated gluten from their diet beforehand.  This can lower the autoimmune response and decrease the symptoms (lower antibody levels,  reduced inflammation and intestinal damage may heal).  

If you weren't eating a sufficient amount of gluten per day in a minimum of two weeks prior to the endoscopy, you may want to do another gluten challenge with repeat endoscopy.

Here's an article that explains, be sure to read the comments. 

 

[ellyelly]

Thanks so much for the link and for your thoughts! I have been on a gluten - containing diet and ramped up my intake in the couple of weeks leading up to the endoscopy, so I’m hopeful that the biopsy is painting an accurate picture. 
 

I don’t quite understand what else might be causing the lymphocytosis and the inflammatory cells/ clusters of plasma cells and struggled to get clarity from the specialist. Perhaps this is common and nothing to be concerned about?!
 

In case relevant, my mother sister are both celiac, and I have the genes:

HLA-DQA1*05:01 = Heterozygous

HLA-DQB1*02:01 = Heterozygous

Thanks again! 

[knitty kitty]

Because of your anemia, you may not be making sufficient antibodies.  I hope they did a total IgA as well as the tTg IgA, and DGP IgG.  I hope you will share the results with us. 

If your body isn't making a large amount of antibodies, then the intestinal damage would be less as well.  The antibodies attacking our own cells is what causes the damage.

Anemia, diabetes, and thiamine deficiency can cause false negatives on antibody tests.  Have you been checked for nutritional deficiencies besides the ferritin?  Several vitamins and minerals are needed to correct iron deficiency.  Have you been taking any vitamin supplements?

Positive on the genes, I see.  Increases the likelihood...  Good job on ramping up on gluten for the test!

Edited January 16, 2025 by knitty kitty
Typo correction

[ellyelly]

Wow - this is all so helpful KnittyKitty. I have just checked and they have done a total iga test thankfully! Will definitely share the results.

How interesting about the impact of iron on antibodies. I had an iron infusion about 1.5 months prior to the endoscopy, but haven’t started supplementing again (awaiting updated tests). I had planned to see a naturopath once I had a clearer picture of whether celiac was a possibility, so will definitely check in about what other supplements might be helpful going forward. Thanks so much for flagging that with me - I had no idea!