Gluten Free Diet Before Endoscopy

[owlettkh]

Im a newbie. I had my gallbladder removed in Jan 07. In the months that followed I started to have a return of abdominal pain along with bloating, loose BMs, gas, weight loss, felt hungry despite eating, numbness and pins and needles tingling in my feet/legs and hands/arms, easy bruising etc. I followed up with my PCP after months of this getting increasingly worse. He intially thought that this may be due to scar tissue constricting my bile duct, but when I went to see him at the end of May 07 he told me he thought it might be Celiac Disease and to test his theory he put me on a gluten free diet. I was on the diet for a month and the symptoms started to improve (except for the numbness/tingling). On July 24th 07, I finally went to see a GI. He scheduled me for blood panels that day and then for and EGD two days later. When I expressed my concern about my gluten free diet for the past nearly 2 months he said to load up on gluten for the 2 days before and I should be fine. Today I had the EGD, but I am still unsure about whether I had enough gluten (i ate 6 slices of bread both days) to get accurately results. The endoscope pics look normal and I am still waiting on biopsy and blood test results. Is it even possible to get accurate results? What should my next step be? my GI told me to go back to the gluten free diet, but I am wondering if i should continue to eat gluten and schedule another EGD? I know that I feel better on the gluten free diet (though it seemed that I was starting to develop a lactose intolerance) but I would like to get an answer to what exactly is wrong even if it means continuing to eat gluten.

Thanks for any help and advice you can offer!

[Guest j_mommy]

Personally I would not trust the results of either the biopsy or blood tests. Especially if you've been gluten-free for 2 months.

Alot of people have problems with lactose before and some once they go gluten-free.

If it were me and this is personal choice, if they come back negative, then I would do a gluten diet and redo blood tests in a couple of weeks. I wouldn't want to go through two endo's so close and the cost is expensive. I would wait to decide on another endo until you get blood work redone once you eat gluten for awhile. The jury is out on how long you should eat gluten, safe bet is atleast two weeks...some say two months.

But I do not truly believe two days of eating gluten is enough after being gluten-free for two months! But who knows....you could still get a positive read!

Let us know what the results are!

[cruelshoes]

After 2 months gluten-free, there is no way that 2 days of gluten would be a long enough challenge. Here is some information you might find helpful. I hilighted the portion in red that seems to most closely apply to your situation. If I were in your shoes, I would be asking myself how important the diagnosis was to me. Would you be willing to remain 100% gluten-free for the rest of your life without the bloodwork/biopsy if that's what your trial gluten-free diet seemed to indicate? If the answer is no, then do the gluten challenge and repeat the biopsy at a later time. If you can commit yourself without looking back without the official diagnosis, then go for it. I know myself well enough to know that I need to see things in black and white before committing, so I did do the bloodwork and biopsy.

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How long do I need to be eating gluten before I am tested for celiac disease?

This is not an easy question to answer. Most people believe, or are told that they need to eat gluten for a few days (or up to a week) before a blood test or a biopsy, and this is incorrect. The true answer depends on how long the individual has been avoiding gluten. How much gluten to eat depends on the age of the individual who is being tested. The information provided here is a general rule, there are many specifics that come into play, so its best to talk with a knowledgable physician about your particular situation.

First: If a patient has avoided gluten for six to 12 months (or more) it is advisable to consider an HLA gene test before a gluten challenge. The HLA gene test will help determine if the patient is even in the risk group for celiac disease. (Only 1/3 of the US population have the genes for celiac disease.) After 6-12 months, it can be difficult to obtain a diagnosis of celiac disease after a gluten challenge, which is why this step is advisable.

Patients who have been on a gluten free diet for less than six months can consider a gluten challenge under a physician's supervision. A challenge would typically require an adult or a child to eat some gluten for four to eight weeks. For some, a twelve week challenge could be required but no challenge should last more than 12 weeks in children. The patient would eat a specified amount of gluten every day.

Many patients are concerned about participating in a challenge. Medical research shows that a limited challenge of this sort provides a greater medical benefit when it leads to a correct diagnosis of celiac disease. The challenge would need to be maintained if a positive antibody test result is received, because the biopsy procedure also depends on the presence of an autoimmune response.

For children, eating a saltine cracker each day would be enough gluten to conduct a challenge and for adults, a slice of bread a day would be adequate. The challenge would need to occur for six to eight weeks before the test in order for it to be accurate. Accordingly, we will not be able to register individuals for the screening who cannot meet this criteria, should they wish to be tested after following the diet.