How Long For Intestine Damage To Be Present

[Jeff Green]

Hi,

I was diagnosed as gluten intolerant many years ago via a blood test. I am now wanting to be tested again through a biopsy of the small intestine. I have been on a gluten free diet for several years and was wondering over what period of time would I need to eat gluten for damage to the villi of the small intestine to occur (in other words how long does it take for the damage to occur - is it only after a short time or a prolonged period?). I just want to be sure that the biopsy is taken at a time when any damge to the villi will have occurred if the intolerance is present.

Any advice on this matter will be most welcome.

Thanks,

Jeff

[gfp]

Hi,

I was diagnosed as gluten intolerant many years ago via a blood test. I am now wanting to be tested again through a biopsy of the small intestine. I have been on a gluten free diet for several years and was wondering over what period of time would I need to eat gluten for damage to the villi of the small intestine to occur (in other words how long does it take for the damage to occur - is it only after a short time or a prolonged period?). I just want to be sure that the biopsy is taken at a time when any damge to the villi will have occurred if the intolerance is present.

Any advice on this matter will be most welcome.

Thanks,

Jeff

Jeff, as a tool as to whether you need a gluten-free diet the biopsy is practically useless and for seeing if you should continue worse than useless. At the same time if it required for other purposes then you are going to have to make yourself very ill. If its for insurance purposes and you need to make sure its positive then you have the problem of making sure its a good sample and also just how damaged the villi have to be before they accept it as proof added to the fact that the chance of misidentification is based on the experience of the person taking the biopsy and the person intepreting the slides. The other use of the biopsy is looking for rather nasty things like cancer or other complications ....

In this case you don't need to eat gluten...

edited to comply with board rules

If you are just doing it for yourself then honestly save the money and discomfort.

Here is a recent article about diagnosis, its in kids but the principle is the same..

Open Original Shared Link

Who warrants a gluten-free diet?

Ford, R. P. K.*

rodney@rodneyford.co.nz

www.rodneyford.co.nz

Paediatric gastroenterology and allergy clinic, Christchurch, New Zealand.

Message: Many more children, other than coeliacs, warrant a gluten-free diet.

Conventionally, medical practitioners have only recommended a gluten-free diet for children with coeliac disease. Doctor Rodney Ford challenges this.

He did an audit of all the children who were referred to him for investigation of coeliac disease (during 2001-2005). Doctor Rodney Ford runs a gastroenterology and allergy clinic, Christchurch, New Zealand.

This group of children all had evidence of an immunological reaction to gluten – they had positive blood tests for IgG-gliadin antibody. Also, they all had an endoscopy to obtain a piece of bowel tissue (a small bowel biopsy).

Finally, they had blood tests to look for evidence of tissue damage (tissue transglutaminase (tTG) or endomesial antibody (EMA))

The novel part of this study was that all of these children with elevated IgG-gliadin antibodies were offered a gluten-free diet, whatever the small bowel histology appearance.

Results: There were 190 children. There were 96 males and 94 females. Their average age was 5.3 years. These children were divided into three groups depending on their test results:

1) 31 (16%) had a histology diagnosis of coeliac disease;

2) 31 (16%) were deemed possible coeliacs because of elevated tTG or EMA antibodies (they had normal small bowel histology);

3) The majority, 128 (67%), did not have any supportive evidence of coeliac disease – they were labelled "not-coeliacs.

The clinical and demographic features were similar across these three groups. Therefore, these groups could not be distinguished from each other by their symptoms.

Of the 128 not-coeliacs, 81 (76%) reported substantial clinical improvements on a gluten-free diet within three months. Of the remaining 47: 31 did not try a gluten-free diet, and 8 reported no benefit.

If the response was measured for only those who tried a gluten-free diet, then 89/97 (92%) of the not-coeliacs got better on a gluten-free diet!

Conclusions: Many children have symptoms that are consistent with coeliac disease. However, most have normal small bowel histology and no evidence of gut damage (normal tTG or EMA results). But they usually have high IgG-gliadin antibody levels.

Notably, these children responded very well to a gluten-free diet, with the great majority improving. – these children are "gluten-sensitive".

This audit shows that IgG-gliadin is a valuable test to detect these children.

[tarnalberry]

If you have been gluten free, then the general rule of thumb is that, for damage to show on a biopsy, you need to eat the equivalent of three slices of bread a day for three months to have a reasonable chance to show damage on a good biopsy (one with multiple (at least four or five) samples taken). Mind, reasonable isn't a guarantee.

[CarlaB]

I did a gluten challenge for six weeks. I got so ill I could not function. I could not drive much of the time because of extreme dizziness. My biopsy showed nothing. If I had it to do over I would not have done it; however, at the time, it was important enough for me to bother with it. I'm a stay-at-home mom -- if I had to go in to a job, it would have been impossible. The best thing that came of it is that gluten repulses me so bad just to look at it because it makes me so sick, that I'm never even tempted!

[gfp]

Mind, reasonable isn't a guarantee.

All too true ... herein lies the problem as a diagnosis ... which combined with the fact you have to deliberatly damage one of your bodies important organs is pretty much why I think its a bad idea.

The very diagnosis itself is based on you damaging one of your bodies important organs and deliberatly at that? and after all that then you have to hope you have a good surgeon and a good interpreter and they take the right samples and then its still not guaranteed.

If its not absolutely necassary then to me any sort of self-harm like this is a bad idea.

The question to ask is if you have a negative biopsy will you start eating gluten again ... would you continue the gluten diet up to a biopsy when it makes you ill and if so why? If after the biopsy you are still ill eating gluten what are you going to do?

[CarlaB]

Someone on another thread made the point that a surgeon doesn't tell someone to start smoking again to see if it's really damaging the lungs. I thought that was an excellent point. After a gluten-challenge, it will take time to heal, again!

[gfp]

Someone on another thread made the point that a surgeon doesn't tell someone to start smoking again to see if it's really damaging the lungs. I thought that was an excellent point. After a gluten-challenge, it will take time to heal, again!

I once read a case study of some Norwegian Dr. who spent 7 years proving some poor kid had coeliac then had the audacity to publish.

I very much doubt he would have spent 7 years of gluten challenges on himself or his own kid!

[KaitiUSA]

Keep in mind that a biopsy can rule celiac in but not out. A biopsy only takes samples of certain areas and there may be sporadic damage. Also, you would have to go back on gluten for a significant amount of time for it to even maybe show damage. At least 3 months eating equal to a few slices of bread a day and even if the biopsy came back negative you could still easily have it.

[jnclelland]

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I couldn't find the article on the web site; can you give me a reference for it? In particular, has this study appeared in the medical literature? I'd like to show it to my son's doctor, but she won't take it seriously unless it has been published somewhere "respectable."

Jeanne

[gfp]

I couldn't find the article on the web site; can you give me a reference for it? In particular, has this study appeared in the medical literature? I'd like to show it to my son's doctor, but she won't take it seriously unless it has been published somewhere "respectable."

Jeanne

This is the article but as for peer review I don't know.

Open Original Shared Link

[jnclelland]

This is the article but as for peer review I don't know.

Open Original Shared Link

Thanks!

Jeanne