Biopsy Reports Confuse Me

[kayavara]

On 4/4/08 I had an endoscopy done.The doctor's office calls a week later and says to come in for a consultation.I get there and he says we need a blood test to check for Celiac because I think you have the signs/symptoms.....although your biopsy came back negative. Your villi are blunted and I want you to inform your family of the situation and go on the celiac diet immediately for 4 months.In August ,we will do another biopsy to see if the villi are healed.The blood tests came back a week later as negative.

I had another appt. on Friday 5/16/08...a follow up. He asked how I felt....lots better on the celiac diet...except for the rare cc....bloating,gas,heartburn,depression,skin issue(not sure if it's DH)etc....all much better.I ask for a report of the biopsy and blood tests.He is able to print out the biopsy report before the printer crashes...they promise to mail the blood tests results,which were negative.

My question comes from reading my report....which states:

FINAL PATHOLOGICAL DIAGNOSIS:

1. Small Bowel:

Moderate Non-Specific Chronic Inflamation

Villous Blunting and Atrophy

No Increase in Intraepithelial Lymphocytes

Comments:

The findings are non-specific and not diagnostic of celiac sprue.

2.Gastric:

Mild Non-specific Chronic Inflamation

No Evidence of Active Acute Inflamation

No Helicobacter-Like Organisms Identified on H&E

3.Esophageal:

Suggestive of Reflux Esophagistis

O.K....the biopsy was suppose to be negative as was the blood tests.He wants me to stay on the diet because I had blunting of the villi. This is where I miss the point.What was negative???He found villi blunting and atrophy.What else would he find to make a positive biopsy?

[psawyer]

I'm puzzled. Villous atrophy was diagnostic of celiac as I understood it. When I had my endoscopy in 2000, the biopsies found "significant villous atrophy" which I was told meant celiac. The GI told me it was an advanced case. That would explain the severity of my symptoms.

I don't know what else might be needed for the biopsy to be considered positive.

I don't know what "No Increase in Intraepithelial Lymphocytes" means.

[Ursa Major]

  Quote

Small Bowel:

Moderate Non-Specific Chronic Inflamation

Villous Blunting and Atrophy

Gastric:

Mild Non-specific Chronic Inflammation

Esophageal:

Suggestive of Reflux Esophagistis

Really, who is the ignorant person who read this report and claimed there is no evidence of celiac disease? That is utterly ridiculous.

You have chronic inflammation of both your small bowel and stomach. You have villous blunting and atrophy. You have damage in your esophagus that suggests reflux.

And then you try the diet and feel so much better.

What else does anybody need to give you a definitive diagnosis of celiac disease? Come on, I am just shaking my head here!

You have celiac disease. No question about it. Keep being on the gluten-free diet and ignore anybody who claims it isn't celiac disease.

[ravenwoodglass]

I agree with the others, the doctor has much more sense than the pathologist. He is a keeper and I fully agree that you need to be on the diet as that was not a negative biopsy report.

[kayavara]

Thank you all so much for the input.I really just couldn't understand where the "negative" reading came in....unless it might be negative of any cancer?? The diet is helping so much...there can hardly be any doubt.You wonder how many histology reports/blood tests come back negative when they are indeed positive....scarey stuff!So many people's futures are in the hands of the person reading the reports.

This sentence in the "comment" section made me wonder me,as well.

"The findings are non-specific and not diagnostic of celiac sprue"

Am I understanding this right.....that celiac and celiac sprue are different?I was under the impression that celiac sprue was really late into the disease with not much hope of reversal of damage.

[psawyer]

"Celiac sprue" is just another name for celiac disease. It is also known as non-tropical sprue and gluten-sensitive enteropathy. All four of these terms (and some rarer others) refer to the same medical condition.

[Tim-n-VA]

I did a google search for "blunted villi", looked at a few of the hits and found this:

  Quote

Although villous atrophy is not exclusive of celiac disease, it is considered a crucial finding. Other causes of blunted villi include tropical sprue, malnutrition, intolerance to cow's milk, soy protein intolerance, and infectious gastroenteritis. However, most of these conditions can be readily excluded on the basis of clinical history and laboratory data.

Combining that with the comment on your report it sounds as if the doctor did not find anything to allow a definitive conclusion about what damaged your villi. The "Intraepithelial Lymphocytes" were what the lab test was looking for that would have been the definitive evidence of gluten caused damage.

[LuvMoosic4life]

  Ursa Major said:

Really, who is the ignorant person who read this report and claimed there is no evidence of celiac disease? That is utterly ridiculous.

You have chronic inflammation of both your small bowel and stomach. You have villous blunting and atrophy. You have damage in your esophagus that suggests reflux.

And then you try the diet and feel so much better.

What else does anybody need to give you a definitive diagnosis of celiac disease? Come on, I am just shaking my head here!

You have celiac disease. No question about it. Keep being on the gluten-free diet and ignore anybody who claims it isn't celiac disease.

I agree. I'm sure many have seen this before, but this doctors states right up front that atrophy of villi is part of celiacs

[kayavara]

Once again........thanks for all the input.It does seem odd to me still...negative biopsy...blunted villous?? I feel like the doctor would not have ordered me to start the diet, inform siblings,see a dietican etc.....if he felt like there was no reason to suspect celiac. We'll see in August,if the villi are still blunted.I hope that's not too soon for the second biopsy.I know everyone heals at a different rate. The worst that can happen is a healthier summer than normal.

Thanks for the help

[ravenwoodglass]

I was thinking about this last night and I am wondering if the line at the bottom may have been an error, perhaps by the transcriptionist. The reading of the biopsy clearly shows impact which makes me wonder if there might have been an error in the transcription. Your doctor obviously recognizes that it was a positive biopsy, have you asked him to explain that line? I would make a call to the office and see if you can get him or a nurse to call you back and clarify. You may find the 'not' was a typo.

[kayavara]

  ravenwoodglass said:

I was thinking about this last night and I am wondering if the line at the bottom may have been an error, perhaps by the transcriptionist. The reading of the biopsy clearly shows impact which makes me wonder if there might have been an error in the transcription. Your doctor obviously recognizes that it was a positive biopsy, have you asked him to explain that line? I would make a call to the office and see if you can get him or a nurse to call you back and clarify. You may find the 'not' was a typo.

The doctor says...via the nurse: The villous blunting and atrophy could also be caused by an acid reflux problem. If that is the case,I had heartburn for about 4 months only (out of 50 years) prior to the scope.Heartburn has never been a huge issue for me...other than Jan-April of this year.I will at times be bothered by it still today...but not very often or very bad.I didn't know that a relatively short episode of heartburn could cause villi blunting and atrophy?? I suppose that is why the "suggestive of reflux esophagitis" was reported in his findings. Maybe I have both problems ....acid reflux and celiac.

Oh and the nurse highly doubted my typo theory....afterall we know that doctors never make mistakes!! Yea right!

[ravenwoodglass]

Yea I guess acid reflux could cause those findings, if the reason for the acid reflux is gluten. Many doctors would rather we take meds for reflux at least your advised you do the diet, at least your doctor advised you to try the diet for relief. That reflux will most likely be a thing of the past soon. If you haven't already you may want to exclude or limit dairy for a bit. It may help you heal faster.

[2kids4me]

Pathology is a complex sub specialty. The reason that lymphocytes are speciifically mentioned is because they were not seen, Autoimmune disorders like celiac have lymphocytic infliltration at the site of damage - in pathology - if you see those cells it tells you with certainty that it is celiac. If they are not seen, then other causes have to be considered- as Tim-n-VA provided in his post.

The doctor acted appropriately as he had other lab data that the pathologist did not - and went to the most likely cause - gluten.

Pathology reports can be confusing - a lot of medical charting and reporting makes you scratch your head at times.

My favorite is the tag attached to an oxygen tank : Not flammable but greatly increases combustion

kind of like - gluten isn't harmful unless you eat it

Sandy