Why The Gluten Challenge?

[Pam]

I've been on a gluten-free diet for 8 weeks now and feel awesome. (I did this before seeing a doctor) Now I went to the doctor and he wants me to do a gluten challenge in order to get a proper diagnosis. He says there definitely is enough evidence to show that I have the disease, but still wants to do the endoscopy after a 4 week challenge. I don't want to eat gluten ever again. Has anyone else been through this? I just know how sick I get now that I've been gluten free and can't imagine eating gluten again for 4 weeks. Help?

[tarnalberry]

Doctor's like *objective* tests that don't rely on *feelings* that you *remember*. There's a point that it could have been something else you changed, or simply a psychosomatic effect. (It's possible, but I'm guessing not real likely for most of us. :-/)

In the end, it's up to you - I don't know that I have a "formal" diagonsis - my blood tests were inconclusive and I haven't had a biopsy, but I don't care about one either...

[Pam]

Well, then if your blood work was inconclusive, didn't your doctor want to do a biopsy? And if so, why did you not do it?

[lyndszai]

Hi Pam

I just finished my gluten challenge 2 days ago now im gluten-free again .I had to go on gluten for 2 1/2 months and I dont even know if it will show up.I was on the diet before I got any test done just like you except my dietician put me on the diet.The 2 /2 months were bad I didnt really care for a diagnoses I knew how I felt when I ate gluten but I had to get the test done for my parents.The diet is also a test itself .How did you happen to go gulten free ? just wondering .Who was it that wanted to know for sure if you had it was it you or you doc .

[kvogt]

A gluten challenge is a way for the doctor to convince him/herself that you have celiac disease. If the biopsy doesn't happen to support the diagnosis, you are left with a dilemma. If you feel better without gluten, go with your gut.

[christtheking]

I'm currious...how long does it take for most of you folks out there to feel the posotive effects of a gluten-free diet. Thanks and all weigh in please...

[plantime]

Is eating the gluten really necessary? If you have only been gluten-free for 8 weeks, was there enough healing for a negative biopsy? I ask this because I went gluten-free Feb 14, and had a biopsy Sep 15. The damage was significant enough that it still showed. Can't he just do a biopsy now, instead of waiting 4 weeks?

[tarnalberry]

My blood tests were inconclusive partly because I had already been gluten-free. I had been fairly good about tracking my symptoms previously, and my doc just suggested doing a dietary challenge one day and seeing how I felt. She did not suggest a biopsy, for what I believe are two reasons: if she was still very uncertain of the results, she would have referred me to a GI, because she's just an internist; and because she realized that I didn't care as much about the rock solid diagnosis as just feeling better.

[plantime]

That's how mine came to be diet-diagnosed in Feb. The endoscopy was ordered to look for ulcers, and the doc found damage from celiac instead. No ulcers, just celiac, which did not cause the problem I was having to begin with! That is why I wonder if the gluten challenge is needed, since an endoscopy and biopsy are being ordered. If it were blood testing, then I could understand the need for the challenge. If there is damage to the villi, is 8 weeks gluten-free long enough to undo it for a biopsy? I was gluten-free for 7 months, had none of the diarrhea and such, and the damage was still enough to show in a biopsy. Is it possible that my damage was worse than originally thought? That healing for me will just take longer? It did feel good to know what the doc was talking about when he said the villi were blunted. He acted like he was afraid to tell me, because of the stigma attached to the word "disease." Or maybe because of the "diet" thing. Any way, wouldn't there still be enough damage for a biopsy to show it now without waiting for a 4 week challenge?

[tarnalberry]

For some people, who aren't having a lot of damage, and heal fast, yeah, 8 weeks could be long enough that the doc won't see it. Maybe they'll get sufficient patchy healing, the doc will biopsy a site that's healed, or will expect totally flat villi for a dx, but they've done some recovery. Negative biospy results are going to be suspect to some degree if you are gluten-free for almost any real length of time before the test. Then again, we've seen people on here before with a negative initial biopsy just because they didn't have total damage, even while on gluten.

[plantime]

I guess I was fortunate that my doctor used a scope to look at my intestinal wall before he took samples. He only took samples for biopsy from areas that were inflamed, he wanted to know why it was that way. I will consider myself one of the lucky few to get a definitive diagnosis without any problems, then! I do feel for anyone that has to go through a gluten challenge, I know how sick it makes me if I slip up.