Duodenal Byopsy, I Doubt Its Sesitivity To Detect Celiac Disease

[dogle]

Hi everyone,

As some of you know I recently tested positive for celiac disease by blood workup. I want to undergo a biopsy of the Dermatitis Herpetiformis for celiac disease instead of duodenal biopsy. However, I have this observation to point out. Let's say I decide to go for duodenal biopsy (gut biopsy) and it turns out to be negative, can I really be sure I don't have celiac disease because the biospy came back negative?? Well, I don't think so. We all know that celiac disease affects the small intestine which is about 7 meters long (incredible, isn't it?) and the biopsy takes different samples from ONLY the duodenum which is just a small porcentage of the small intestine length. I know endoscopes can't go any further than the duodenum. I've read the small intestine is formed by the duodenum (26 cm), yeyunum (2.5 meters), and ileoum (3.5 meters) (source wikipedia), so the rest majority of the small intestine (which is also affected by celiac disease) can be unexoplored or be more damaged than the duodenum. They test for positivity and even stage just from the duodenum samples. Just imagine someone who has a negative blood antibody test and a negative duodenum biopsy, is it valid? Well the rest of the gut can be affected and the duodenum respected. Doctors might say "you have a small degree of damage" just by taking into account the duodenal biopsy, but in fact there could be more damage in the rest of the small intestine and the disease fall into a more severe stage. I don't really know whether celiac disease only affects the duodenum, because if it only does, then my observation will be discarded but I don't think it only affects the duodenum since the severity of the symtoms can't be explained by just sayng that the duodenum damage provokes them. I guess someone who has duodenitis my get some celiac symtoms, my sister has had duodenitis but no celiac disease symptoms.

It may also demostrate why some persons who have a negative blood work up and just negative DUODENAL biopsy might sill benefit from gluten free diet since some other parts of the samll intestine, rather than just the duodenum, might be affected. I don't know more reseach should be sought.

[dogle]

Well I just read it affects primary the upper small intestine, does it mean the rest of the small intestine isn't damaged?

Just take a look at this celiac disease article: The diangostic criteria developed by the European Society for Pediatric Gastroenterology and nutrition requires only clinical improvement with the diet................ keep reading here:

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However, I guess the diangosis crteria is differen in the US, the article may be wrong in that part since I haven't found something that confirms what they state about the European Society.

IT WOULD BE PRETTY UNRESPONSIBLE NOT TO PERFORM THE DUODENAL BIOPSY BY NOW, THOUGH. Pretty confusing.