Duodenum biopsy result confusion

[jamiet06]

Hello,

I hope I am posting this in the correct space, so apologies if not!

After my last two endoscopies (2019 and 2024), I received the following comment in my report:

Duodenal biopsy: Duodenal mucosa with mild intra-epithelial lymphocytosis

in the presence of normal villous architecture.

Comment: Findings are non-specific. They can be seen in coeliac disease, peptic

or medication induced injury and H.pylori infection among others. Correlation

with clinical findings and results of serological studies is recommended.

I didn't have an ulcer and crohns disease was not mentioned to me. For the past few years I have had on and off digestive issues (gas, mild diarrhea, lower abdominal bloating). Just recently I went to my GP and he stated it was probably all related to IBS, however, I forgot to mention this statement from my endoscopy report. Does this sound like it is pointing towards celiacs? I am a 52 year old male.

Any advice would be awesome.

Thank you

[knitty kitty]

Welcome to the forum, @jamiet06,

Yes, it does point in that direction. 

Your report says "Correlation with clinical findings and results of serological studies is recommended"  is saying you should undergo a gluten challenge and be tested for antibodies associated with Celiac Disease.   These antibodies are produced in celiac disease in response to gluten, but you have to eat generous amounts of gluten for the antibodies to show up in the bloodstream.

A gluten challenge means you eat 10 grams or more of gluten  (4 to 6 slices of gluten containing bread or equivalent or more) per day for a minimum of two weeks.  

[Scott Adams]

Your biopsy findings—specifically the intra-epithelial lymphocytosis with normal villi—are what we call "Marsh Stage 1" changes, which can indeed suggest early or potential celiac disease, especially given your ongoing digestive symptoms (bloating, diarrhea). While these changes aren’t definitive for celiac on their own (they can also occur with H. pylori, NSAID use, or even IBS), they absolutely warrant further investigation given your symptoms. Here’s what I’d recommend: First, ask your GP or gastroenterologist to run the full celiac blood panel (tTG-IgA, EMA, and total IgA to rule out deficiency) if you haven’t had them recently—these results, combined with your biopsy findings, could clarify whether gluten is the trigger. If you’ve been eating gluten consistently before testing, the bloodwork should be reliable; if not, you may need a short gluten challenge. Second, consider testing for H. pylori (via stool antigen or breath test) and reviewing any medications (like NSAIDs) that could contribute to the lymphocytosis. While IBS could explain some symptoms, it doesn’t cause these histological changes. Given your age and chronic issues, it’s worth pushing for answers—untreated celiac can develop at any age, and even mild damage can cause systemic effects. A consult with a gastroenterologist familiar with celiac’s "gray zone" cases would be ideal to connect all the dots.

[jamiet06]

Thank you for your replies.

I requested my endoscopy results from May 2024 to see if this was the same. In that report, it states everything is normal. So my thinking is no celiacs. My GP recently told me he thinks I have IBS. Is it a concern that I had the lymphocytosis 5 years ago and then nothing last year?

I am concerned my doctors don't make any of this clear, making us all resort to seeking the assistance of a great community such as this.

Thanks again

[knitty kitty]

@jamiet06,

Have you thought about getting a genetic test done?  You have to have genes for Celiac Disease to develop.  If you don't have any of the commonly known Celiac genes, you can look for another diagnosis.  Genes don't change.  You don't have to do a gluten challenge to test for genetic markers of Celiac Disease.

[jamiet06]

Thank you Knitty kitty, no I haven't thought about that. I just assumed that because my biopsy showed no lymphocytosis, celiacs was off the table. 

Is it possible to have no lymphocytosis and still have celiacs?

[Scott Adams]

I just want to also mention that if you decide to get a blood panel done for celiac disease you'll need to do a gluten challenge. 

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:

 

 

[Scott Adams]

By the way, this new article is very relevant to this thread:

 

[knitty kitty]

Yes, it is possible to have Celiac Disease without lymphocytosis.  

[jamiet06]

Thank you both for your kind assistance.

I really appreciate the effort strangers go to helping others seeking advice. I will endeavour to have the recommended tests done and will update this post. 

Thank you again for being so helpful!

 

[Scott Adams]

Let us know how things turn out--believe it or not it may help others who search and find this thread years from now.

[Diana Swales]

On 5/6/2025 at 7:52 AM, jamiet06 said:

Thank you Knitty kitty, no I haven't thought about that. I just assumed that because my biopsy showed no lymphocytosis, celiacs was off the table. 

Is it possible to have no lymphocytosis and still have celiacs?

 lymphocytosis is also an indication of an infection so that might be the cause of the difference.  In the one you had a slight infection and the other you didnt