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Husker_Tim

Can A Doctor Diagnose Celiac During An Endoscopy Before Examing The Biopsy?

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My daughter has been suffering from nausea and diarrhea for years. We recently had bloodwork done and her Celiac screen came back "moderately positive" (score of 45?). The GI doctor recommended an endoscopy, even though we've had one previously. We believe the previous endoscopy came back negative because the previous GI only performed one or very few biopsies and just missed it.

Immediately upon completing the recent endoscopy, while waiting in recovery, the GI doctor told us he didn't find anything and that she didn't have Celiac, but maybe IBS. Doesn't a pathologist have to examine the biopsies under a microscope to make that diagnosis? Does this doctor know what he is talking about?

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In cases of severe damage to the villi, the doctor may be able to detect the damage during the procedure and give a tentative diagnosis of celiac. Typically the damage is not that severe, and only the examination of the biopsies can lead to negative finding.

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Immediately upon completing the recent endoscopy, while waiting in recovery, the GI doctor told us he didn't find anything and that she didn't have Celiac, but maybe IBS. Doesn't a pathologist have to examine the biopsies under a microscope to make that diagnosis? Does this doctor know what he is talking about?

There can be signs of celiac like scalloping of the intestines and inflammation but as Peter says they are not always present. There can be no diagnosis until pathology examines her slides.

Also, it's worth trying the gluten-free diet to see if it resolves her issues with a moderate positive blood tests. Developing celiac is a process and often the only sign you will have in someone with milder autoimmunity is a bunch of GI symptoms but only one positive test.

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You are right, the pathologist is the last word on the results of the biopsy.

Especially when giving counts of Eosinophils related to Eosinophilic Gastrointestinal disorders as another example of what the naked (scoping) eye can miss during an endoscopy.

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There IS a reason why they use a microscope :ph34r:

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I had a similar experience except the Dr. told me I looked normal so he didn't bother with the biopsy... I think it's certainly possible that you can see it without a biopsy but why would the gold standard be a biopsy if you could see all cases with the naked eye? Hmmmm... :)

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My daughter has been suffering from nausea and diarrhea for years. We recently had bloodwork done and her Celiac screen came back "moderately positive" (score of 45?). The GI doctor recommended an endoscopy, even though we've had one previously. We believe the previous endoscopy came back negative because the previous GI only performed one or very few biopsies and just missed it.

Immediately upon completing the recent endoscopy, while waiting in recovery, the GI doctor told us he didn't find anything and that she didn't have Celiac, but maybe IBS. Doesn't a pathologist have to examine the biopsies under a microscope to make that diagnosis? Does this doctor know what he is talking about?

they DID take biopsies, didn't they??

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There can be no diagnosis until pathology examines her slides.g.gif

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