Jump to content
This site uses cookies. Continued use is acceptance of our Terms of Use and Privacy Policy. More Info... ×
  • Welcome to Celiac.com!

    You have found your celiac tribe! Join us and ask questions in our forum, share your story, and connect with others.




  • Celiac.com Sponsor (A1):



    Celiac.com Sponsor (A1-M):


  • Get Celiac.com Updates:
    Support Our Content
    eNewsletter
    Donate
  • Dr. Scot Lewey
    Dr. Scot Lewey

    Endoscopy in Celiac Disease by Dr. Scot Lewey

    Reviewed and edited by a celiac disease expert.

    Journal of Gluten Sensitivity Summer 2007 Issue. NOTE: This article is from a back issue of our popular subscription-only paper newsletter. Some content may be outdated.

    Endoscopy in Celiac Disease by Dr. Scot Lewey - During upper endoscopy a thin flexible tube, about the diameter of a fat pencil, is passed in the mouth down the upper gastrointestinal tract. Image: CC BY 2.0--Army Medicine
    Caption: During upper endoscopy a thin flexible tube, about the diameter of a fat pencil, is passed in the mouth down the upper gastrointestinal tract. Image: CC BY 2.0--Army Medicine

    Celiac.com 04/16/2021 - When undergoing an evaluation for possible Celiac disease or gluten sensitive enteropathy doctors usually recommend an upper endoscopy with small intestinal biopsy. What that is and why it is recommended may not be clear to many people who are facing the decision of whether to undergo the procedure themselves or whether to subject their child to this exam.

    What is an endoscopy and how is it done?

    During upper endoscopy a thin flexible tube, about the diameter of a fat pencil, is passed in the mouth down the upper gastrointestinal tract. This tube has a video chip on its tip. From the mouth it is advanced down the esophagus, or inside a feeding tube, into the stomach. It is then advanced into the first part of the small intestine known as the duodenum. Thus, upper endoscopy is also known as esophagogastroduodenoscopy or EGD for short. The scope has internal channels for flushing water, suctioning secretions and passing instruments that can obtain pinch biopsy samples of tissue for microscopic examination. The scope dials control internal cables that allow the tube to be turned up/down and right/left at the tip. 

    Do you feel and endoscopy or remember it?

    Celiac.com Sponsor (A12):
    Typically, people undergoing the exam in the U.S. are sedated with medication. These medications are similar to Valium. They have a good amnesia and relaxing effect and are called midazolam or versed and are usually combined with a narcotic pain medication like meperidine (Demerol) or Fentanyl. The result is a sort of drowsy twilight amnesia. Lately, a very short-acting intravenous sedative, called propofol (diprovan) is increasingly being used for deeper sedation or general anesthesia. Occasionally, usually in very young children or people with severe lung problems, general anesthesia is required. The exam is usually not felt or remembered because of the medications.

    What is examined and how well is the lining is seen?

    Celiac disease affects the upper portion of the small intestine, in the two sections known as the duodenum and jejunum. The examination of the small intestine is usually limited to the first section, termed the duodenum, though occasionally the second section known as the jejunum may be reached especially when a longer endoscope is used. The video images are very high resolution with the latest endoscopes and may have a magnification and color contrast mode to detect very subtle signs of damage of the small intestine.

    What are the typical endoscopy findings?

    The characteristic appearance of the surface of the small intestine in celiac disease includes superficial ulcerations that are commonly linear, flattening of the folds, notching or scalloping of the folds and a mosaic-like pattern. However, the surface may appear normal and only under microscopic examination of samples will the lining show signs of gluten-induced injury.

    What are intestinal biopsies? What are their limitations? What can be missed?

    Samples of small intestine are obtained with biopsy forceps that consist of tiny jaws with cups that permit pinching off samples of the intestinal lining. This is painless and very safe. The samples are placed in a preservative solution and sent to a pathology lab. The tissue is then processed, embedded in paraffin wax, cut into thin slices and mounted on a microscope slide. The slides are stained before being examined under the microscope by a pathologist. Small intestine injury from gluten may be patchy.  Therefore, several samples are recommended. A minimum of 4 pieces and preferably 8 to 12 samples should be obtained to avoid missing microscopic signs of Celiac disease.

    What does the pathologist look for on the slides to determine if there is Celiac disease or gluten injury?
    The pathologist examines the slide for evidence of damage or injury characteristic of gluten sensitivity. Occasionally special stains are required to see signs of irritation known as inflammation. Inflammation in the gut is characterized by an increased number of a type of white blood cells. For Celiac disease the characteristic white blood cell involved in gluten-induced intestinal injury are called lymphocytes. In early celiac and gluten sensitivity without celiac disease, the biopsy may be normal and the diagnosis may not be established by intestinal biopsy without special stains or, in the research setting, by electron microscopy.

    Summary

    The procedure of endoscopy is safe, painless, and very helpful for confirming the diagnosis of celiac disease while excluding other upper intestinal disorders. However, the main drawback of endoscopy is that nearly everyone must have sedation to tolerate the exam and it can be expensive if not fully covered by the patient’s insurance. Furthermore the biopsies may not confirm the diagnosis. If the biopsy is normal, misread as normal, or is borderline, the diagnosis of celiac disease is neither confirmed nor excluded. 

    Sometimes, celiac disease is diagnosed by endoscopic biopsy in people who either have normal blood tests or as an incidental finding in those undergoing endoscopy for other reasons. When the biopsy is abnormally classic for Celiac disease and the blood tests are negative but the patient responds to a gluten-free diet, the term seronegative (blood test negative) celiac disease is often used. Fear or confusion about endoscopy should not prevent anyone who is suspected of having celiac or gluten sensitivity from undergoing endoscopy.



    User Feedback

    Recommended Comments

    There are no comments to display.



    Create an account or sign in to comment

    You need to be a member in order to leave a comment

    Create an account

    Sign up for a new account in our community. It's easy!

    Register a new account

    Sign in

    Already have an account? Sign in here.

    Sign In Now

  • Get Celiac.com Updates:
    Support Celiac.com:
    Donate
  • About Me

    Dr. Scot Lewey

    A practicing gastroenterologist in direct patient care but who also participates in teaching medical students and physicians in training as a Clinical Professor of Medicine at Rocky Vista University College of Osteopathic Medicine and at Kansas City University of Medicine and Biosciences. In addition to authoring peer review articles, book chapters and presenting clinical research Dr. Lewey has conducted, he has authored over 50 online articles, numerous blog posts and tweets about digestive and food related issues. As a physician who is a fellow of six professional societies Dr. Lewey serves at a national level on several committees, as a reviewer for journal articles and case reports, a media representative for the AOA Media and ACG on digestive health and disease and has been featured in various print, television, podcast and online media publications about digestive issues. As a expert in digestive diseases Dr. Lewey is also a medical legal consultant and expert witness. Dr. Lewey can be reached at Facebook.com/thefooddoc, on twitter @thefoodgutdoc and his blog www.thefooddoc.blogspot.com.


  • Celiac.com Sponsor (A17):
    Celiac.com Sponsor (A17):





    Celiac.com Sponsors (A17-M):




  • Related Articles

    Jefferson Adams
    Mandy Moore Takes Her Upper Endoscopy Test for Celiac Disease to Instagram
    Celiac.com 11/30/2017 - Talk about handling a celiac disease diagnosis in style. This past summer, "Us" star Mandy Moore showed us how its done, when she documented the process of working with her doctor to determine if she had celiac disease.
    She even posted a photo of her endoscopy visit for her Instagram followers. Moore captioned the post:

    "Grog city. Just had an upper endoscopy to officially see whether or not I have celiac (only way to officially diagnose)…things are looking 👌)."
    Later, and also on Instagram, she revealed that she had been diagnosed with celiac disease.
    "Well, this definitely takes the (now gluten free cake) for bummer news," she wrote on her Instagram story at the time. "Any celiac sufferers out there with any helpful tips??"
    Maybe consid...


    Antonio Tursi, M.D.
    Endoscopy in Celiac Disease
    Celiac.com 08/30/2018 - Celiac disease is a disorder characterized by a clinical syndrome of intestinal malabsorption and a characteristic though not specific histological lesion consisting in total, subtotal or partial small-bowel villous atrophy (predominating in the proximal segments).  A correct gluten-free diet results in clinical and histological improvement(1,2).  It has become increasingly apparent that the prevalence of celiac disease is higher than previously thought, and that this is mainly because of increasing awareness of atypical, mildly symptomatic, or silent cases(3).  Therefore, many patients have upper gastrointestinal endoscopy as an initial investigation, which provides an opportunity to perform a biopsy in the second portion of the duodenum.  
    The role of end...


    Jefferson Adams
    Can Small Bowel Capsule Endoscopy Help Spot Active Celiac Disease?
    Celiac.com 02/26/2020 - Patients with established celiac disease can present with signs and symptoms requiring small bowel capsule endoscopy (SBCE) to assess for persistent disease beyond the duodenum and to rule out complications. 
    There is limited data celiac disease and histology, clinical and serological parameters as they reflect the extent of celiac disease on small bowel capsule endoscopy.
    A team of researchers recently set out to assess the role of small bowel capsule endoscopy in established celiac disease, by looking at the relationship between symptoms, celiac disease serology and Marsh classification of disease and extent of disease on small bowel capsule endoscopy in patients with established celiac disease.
    The team included S. Chetcuti Zammit; M. Kurien; ...


    Scott Adams
    Is Small-Bowel Capsule Endoscopy Useful in Cases of Equivocal Celiac Disease?
    Celiac.com 05/07/2020 - Seronegative villous atrophy (SNVA), raised intraepithelial lymphocytes (IELs) and crypt hyperplasia on duodenal histology can be caused by celiac disease or by drugs or infections.
    A team of researchers recently set out to assess the role of small-bowel capsule endoscopy (SBCE) in these patients and to determine SBCE findings at diagnosis can predict disease outcome.
    The research team included Stefania Chetcuti Zammit, Annalisa Schiepatti, Imran Aziz, Matthew Kurien, David S. Sanders, and Reena Sidhu. They are variously affiliated with the Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK, and the Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield Medical ...


  • Recent Activity

    1. - Wheatwacked replied to lsky's topic in Post Diagnosis, Recovery & Treatment of Celiac Disease
      2

      Question on if i can contact my gastro doctor whenever?

    2. - trents replied to lsky's topic in Post Diagnosis, Recovery & Treatment of Celiac Disease
      2

      Question on if i can contact my gastro doctor whenever?

    3. - lsky posted a topic in Post Diagnosis, Recovery & Treatment of Celiac Disease
      2

      Question on if i can contact my gastro doctor whenever?

    4. - trents replied to Juliana82's topic in Celiac Disease Pre-Diagnosis, Testing & Symptoms
      1

      Symptoms after ingesting gluten

    5. - Wrensmith replied to CatLady15's topic in Celiac Disease Pre-Diagnosis, Testing & Symptoms
      4

      Toddler Diagnosis?


  • Celiac.com Sponsor (A19):



  • Member Statistics

    • Total Members
      126,259
    • Most Online (within 30 mins)
      7,748

    Celiacaf
    Newest Member
    Celiacaf
    Joined

  • Celiac.com Sponsor (A20):


  • Forum Statistics

    • Total Topics
      120.9k
    • Total Posts
      69.3k

  • Celiac.com Sponsor (A22):





  • Celiac.com Sponsor (A21):



  • Popular Now

    • llisa
      20
    • More2Learn
      9
    • ellanataliw
      6
  • Popular Articles

    • Scott Adams
    • Scott Adams
    • Scott Adams
    • Scott Adams
    • Scott Adams
  • Upcoming Events

×
×
  • Create New...