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Is This Enough For A Diagnoses?


ANDOBEAR

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ANDOBEAR Apprentice

I had a biopsy done and the nurse practitioner at my gastrointerologist suspects celiac based on my symptoms and the results. She did order the blood test just for correlation. The results of the blood tests are not in yet but this is what the biopsy report says

1. DUODENAL BIOPSY

- DUODENAL MUCOSA WITH FOCALLY INCREASED INTRAEPITHELIAL LYMPHOCYTES AT THE VILLOUS TIP AND UNDERLYING LYMPHOID FOLLICLE.

- THESE CHANGES, ALTHOUGH NON-SPECIFIC, HAVE BEEN ASSOCIATED WITH CELIAC DISEASE. CLINICAL CORRELATION SUGGESTED.

2. GASTRIC BIOPSY

- GASTRIC MUCOSA WITH CHRONIC GASTRITIS, NO ACTIVITY.

- NO INTESTINAL METAPLASIA OR DYSPLASIA SEEN.

- NO H.PYLORI-LIKE ORGANISMS IDENTIFIED ON GIEMSA STAIN.

So is this enough or do I have to have a positive bllod test or some other test for correlation?


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Lisa Mentor
I had a biopsy done and the nurse practitioner at my gastrointerologist suspects celiac based on my symptoms and the results. She did order the blood test just for correlation. The results of the blood tests are not in yet but this is what the biopsy report says

1. DUODENAL BIOPSY

- DUODENAL MUCOSA WITH FOCALLY INCREASED INTRAEPITHELIAL LYMPHOCYTES AT THE VILLOUS TIP AND UNDERLYING LYMPHOID FOLLICLE.

- THESE CHANGES, ALTHOUGH NON-SPECIFIC, HAVE BEEN ASSOCIATED WITH CELIAC DISEASE. CLINICAL CORRELATION SUGGESTED.

2. GASTRIC BIOPSY

- GASTRIC MUCOSA WITH CHRONIC GASTRITIS, NO ACTIVITY.

- NO INTESTINAL METAPLASIA OR DYSPLASIA SEEN.

- NO H.PYLORI-LIKE ORGANISMS IDENTIFIED ON GIEMSA STAIN.

So is this enough or do I have to have a positive bllod test or some other test for correlation?

There should be a diagnosis/conclusion section of your pathology report. A positive biopsy IS diagnoses enough for Celiac. As also in blood test, biopsies are not always accurate. Both tests can rule Celiac in, but they can't rule it out.

ravenwoodglass Mentor
I had a biopsy done and the nurse practitioner at my gastrointerologist suspects celiac based on my symptoms and the results. She did order the blood test just for correlation. The results of the blood tests are not in yet but this is what the biopsy report says

1. DUODENAL BIOPSY

- DUODENAL MUCOSA WITH FOCALLY INCREASED INTRAEPITHELIAL LYMPHOCYTES AT THE VILLOUS TIP AND UNDERLYING LYMPHOID FOLLICLE.

- THESE CHANGES, ALTHOUGH NON-SPECIFIC, HAVE BEEN ASSOCIATED WITH CELIAC DISEASE. CLINICAL CORRELATION SUGGESTED.

2. GASTRIC BIOPSY

- GASTRIC MUCOSA WITH CHRONIC GASTRITIS, NO ACTIVITY.

- NO INTESTINAL METAPLASIA OR DYSPLASIA SEEN.

- NO H.PYLORI-LIKE ORGANISMS IDENTIFIED ON GIEMSA STAIN.

So is this enough or do I have to have a positive bllod test or some other test for correlation?

What they are saying in the area that I bolded is that the changes they have seen are suggestive of celiac and when they refer to clinical correlation I believe they are saying that it is likely the cause if your symptoms are suggestive of celiac. It does not appear that your doctor did any biopsies of the small intestine villi but concentrated on your duodenum and stomach. Based on this I would certainly give the diet a real good shot for a few months.

The blood test, if you haven't yet gone gluten free could be useful BUT only if it is positive . If you have already had the blood draw and then go ahead and go gluten free. You may have your answer before the blood tests come back.

ANDOBEAR Apprentice
There should be a diagnosis/conclusion section of your pathology report. A positive biopsy IS diagnoses enough for Celiac. As also in blood test, biopsies are not always accurate. Both tests can rule Celiac in, but they can't rule it out.

The diagnoses portion just states GASTRITIS, HIATAL HERNIA

I guess its not in the diagnose section because the report stes clinical correlation is reccommended.

I should also mention this gastroscopy was NOT done to diagnose Celiac. I was being tested for Reflux. We are only exploring the possibility of celiac after the biopsy results. Looking at it now I do have many symptoms and a family history. I thought I had lactose intolerance my whole life and blamed my GI issues on that. After a breath test came up negative for lactose intolerance I definately think Celiac might be the root of my GI issues and several others.

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    • trents
      Let me hasten to add that if you will be undergoing an endoscopy/biopsy, it is critical that you do not begin efforts to reduce gluten beforehand. Doing so will render the results invalid as it will allow the small bowel lining to heal and, therefore, obscure the damage done by celiac disease which is what the biopsy is looking for.
    • Scott Adams
      This article, and the comments below it, may be helpful:    
    • Scott Adams
      That’s a really tough situation. A few key points: as mentioned, a gluten challenge does require daily gluten for several weeks to make blood tests meaningful, but negative tests after limited exposure aren’t reliable. Dermatitis herpetiformis can also be tricky to diagnose unless the biopsy is taken from normal-looking skin next to a lesion. Some people with celiac or DH don’t react every time they’re exposed, so lack of symptoms doesn’t rule it out. Given your history and family cancer risk, this is something I’d strongly discuss with a celiac-experienced gastroenterologist or dermatologist before attempting a challenge on your own, so risks and benefits are clearly weighed.
    • Greymo
      https://celiac.org/glutenexposuremarkers/    yes, two hours after accidents ingesting gluten I am vomiting and then diarrhea- then exhaustion and a headache. see the article above- There is research that shows our reactions.
    • trents
      Concerning the EMA positive result, the EMA was the original blood test developed to detect celiac disease and has largely been replaced by the tTG-IGA which has a similar reliability confidence but is much less expensive to run. Yes, a positive EMA is very strong evidence of celiac disease but not foolproof. In the UK, a tTG-IGA score that is 10x normal or greater will often result in foregoing the endoscopy/biopsy. Weaker positives on the tTG-IGA still trigger the endoscopy/biopsy. That protocol is being considered in the US but is not yet in place.
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