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

Biopsy results over the phone


Kelly1920

Recommended Posts

Kelly1920 Rookie

I have an appointment for my biopsy results to be given over the telephone in two weeks time, having been in for the biopsies this week. Is this likely to mean it is negative? Or are telephone results normal? 

I had positive TTg and a weakly positive EMA blood test but no visual damage on the endoscope to the naked eye. 

What questions should I ask during the telephone consultation? 

Had symptoms for around 12 years - went gluten free for two months at a friend’s suggestion and did feel better- and then did the gluten challenge for three weeks for biopsy and blood tests, after my doctor begrudgingly agreed to test for it. I’m in the UK. 

Link to comment
Share on other sites

Celiac.com Sponsor (A8):
Celiac.com Sponsor (A8):



Celiac.com Sponsor (A8-M):



plumbago Experienced

"Did you see anything on endoscopy that could explain my symptoms?"
"How did my esophagus look?"

Also there's something called the Marsh scale which you may want to familiarize yourself with to see if where the results fall on that scale (if they do).
Generally I would surmise that because it's a phone appt that does mean your results are likely negative, but could it be that with Covid they are trying to limit exposure and are doing everything over the phone?


Others should have something to add, as well.

Good luck.

Link to comment
Share on other sites
Scott Adams Grand Master

Just know that your blood test results may be telling you the answer. Over the years many in your shoes with positive blood tests but negative biopsy results decide to continue to eat gluten, only to realize later that gluten causes them serious issues. The gut damage is typically considered the final stage of celiac disease, and it’s best avoided.

Link to comment
Share on other sites
trents Grand Master

I'm not sure that "no visual damage on the endoscope to the naked eye" is good enough. Did they not do a biopsy and look at it at the microscopic level? I would be encouraged by he naked eye analysis only if it stood in stark contrast to obvious damage in previous endoscopies.

Link to comment
Share on other sites
Kelly1920 Rookie
1 hour ago, trents said:

I'm not sure that "no visual damage on the endoscope to the naked eye" is good enough. Did they not do a biopsy and look at it at the microscopic level? I would be encouraged by he naked eye analysis only if it stood in stark contrast to obvious damage in previous endoscopies.

They took six biopsies. I’m hoping they will be able to give me some confirmation from that in the telephone appointment they’ve arranged for a couple of week’s time.

The fact that there’s no visible damage and that everything looks “normal” should be encouraging, I suppose. 

Link to comment
Share on other sites
DJFL77I Experienced

i dont think you can see villi damage with naked eye

Link to comment
Share on other sites
plumbago Experienced
30 minutes ago, DJFL77I said:

i dont think you can see villi damage with naked eye

FWIW, my GI met with me minutes after my 'scope and said he could tell there was damage, which was likely a result of villi blunting.

Link to comment
Share on other sites

Celiac.com Sponsor (A8):
Celiac.com Sponsor (A8):



Celiac.com Sponsor (A8-M):



Kelly1920 Rookie
6 minutes ago, plumbago said:

FWIW, my GI met with me minutes after my 'scope and said he could tell there was damage, which was likely a result of villi blunting.

Yeah- my colleague was diagnosed on the spot, by sight, after the endoscopy. So I took the comment of “normal” as a positive sign that it might not be coeliac.

Link to comment
Share on other sites
DJFL77I Experienced

Mine saw nothing.. until biopsy saw it..

Link to comment
Share on other sites
cyclinglady Grand Master

It depends on the type of scopes.  My endoscopy looked fine, but biopsies revealed some severe damage.  The magnification on the scope used on my follow up was tremendous.  You could visually see villi.  But my GI still took biopsies.   You have to wait for the pathologist’s report.  And doing thing over the phone?  Normal.  My biopsy results were done over the phone seven years ago.  More recently, an email.  My kid just “saw” her doctor on the phone.  Times are changing.....

Link to comment
Share on other sites
Kelly1920 Rookie
2 hours ago, cyclinglady said:

It depends on the type of scopes.  My endoscopy looked fine, but biopsies revealed some severe damage.  The magnification on the scope used on my follow up was tremendous.  You could visually see villi.  But my GI still took biopsies.   You have to wait for the pathologist’s report.  And doing thing over the phone?  Normal.  My biopsy results were done over the phone seven years ago.  More recently, an email.  My kid just “saw” her doctor on the phone.  Times are changing.....

Guess I will have to wait and see! 
Thank you for sharing! 

Link to comment
Share on other sites
docaz Collaborator
On 8/29/2020 at 4:46 AM, plumbago said:

FWIW, my GI met with me minutes after my 'scope and said he could tell there was damage, which was likely a result of villi blunting.

 

On 8/29/2020 at 5:03 AM, DJFL77I said:

Mine saw nothing.. until biopsy saw it..

 

On 8/29/2020 at 4:15 AM, DJFL77I said:

i dont think you can see villi damage with naked eye

This is absolutely true. Villi or so tiny that they are far too small to be seen by the eye no matter what scope is used. The endoscopy can show redness or ulcerations of the esophagus, stomach and small intestine but it is absolutely impossible to diagnose blunted villi or celiac disease from that. There are many, many conditions that cause changes in GI tract and celiac disease is in fact one of the less common ones. Stomach ulcers and inflammation unrelated to celiac disease is much more common. Furthermore in order to diagnose celiac disease not only do you have to see what is on the surface but also the type of white cells that are in lining of the small intestine. In my opinion, it is also a very fine line what a doctor should or should not say right after the scope in particular since there is a lot of unknown until the tissue is examined. I perform a good number of biopsies (in a different area) and I am often looking for cancer and I am very thoughtful what I say not to put someone through emotional distress or giving false hopes. 

Link to comment
Share on other sites
plumbago Experienced

@docaz Just to be clear, the part you quoted from me says damage done likely as a result of villi blunting. This was the doc said to me at the endoscopy center right after my EGD (ie, before biopsy results): "Good chance of having Celiac. Lining looks a little atrophic. Will have to wait until bx comes back." The report's finding (under "Findings") has: "In the duodenal bulb and 2nd duodenum no villi were seen." This was in the prelim and final reports.  As an experienced endoscopist yourself, perhaps you can parse the meaning of that, I'm just sharing what my own doctor said to me and what was in the reports, 10 years ago.

Link to comment
Share on other sites
docaz Collaborator
1 hour ago, plumbago said:

@docaz Just to be clear, the part you quoted from me says damage done likely as a result of villi blunting. This was the doc said to me at the endoscopy center right after my EGD (ie, before biopsy results): "Good chance of having Celiac. Lining looks a little atrophic. Will have to wait until bx comes back." The report's finding (under "Findings") has: "In the duodenal bulb and 2nd duodenum no villi were seen." This was in the prelim and final reports.  As an experienced endoscopist yourself, perhaps you can parse the meaning of that, I'm just sharing what my own doctor said to me and what was in the reports, 10 years ago.

I want to make sure that you do not mislead you. I do not do endoscopies but work in the head and neck and the mouth areas.

What the doctor probably meant to say is that the surface appeared smooth and very shiny rather than the typical velvet-like texture that one expects if the villi are present. The difference in wording might sound like semantics but it is not. In any case, the actual biopsy report is the most important one. (When my kids were diagnosed, I actually requested the images of the pathology slides and the pathologist was actually very happy to go over them with me). In addition to blunted villi, there has to be also a certain type of neutrophilic infiltrate (specific white blood cells in the lining) visible under the microscope. Misdiagnosis in particular when the pathologists are not experienced is quite common. For that reason, for diagnosis itself the blood tests are very important and possibly even more important than the biopsy (but prominent experts disagree on this). Even if the biopsy is negative and the blood tests are positive a gluten-free diet is recommended by most clinicians. The biopsy is most important in case follow up biopsies are performed to evaluate the healing (or lack thereof) the disease. Here is a paper that is a little hard to read but you can see in table 2 other conditions that can mimick celiac disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587842/ . That said, there are newer scopes that have a very high magnification and the resolution is constantly improving and it would not be inconceivable that sometimes soon villi could be seen. 

Link to comment
Share on other sites
cyclinglady Grand Master

I had an endoscopy two years ago.  My GI could see the villi.  Me too, because he gave me photos to celebrate my healing.  Of course, he still submitted biopsies to confirm.  
 

This is not my photo, but it looked like this:

https://www.sciencephoto.com/media/609573/view/small-intestine-endoscope-view

Again, my new GI has the most current equipment.  My diagnosing GI had an older model (2013)  which could not see villi.  I had to wait for the biopsies to confirm.  

Link to comment
Share on other sites
cyclinglady Grand Master
4 hours ago, docaz said:

I want to make sure that you do not mislead you. I do not do endoscopies but work in the head and neck and the mouth areas.

What the doctor probably meant to say is that the surface appeared smooth and very shiny rather than the typical velvet-like texture that one expects if the villi are present. The difference in wording might sound like semantics but it is not. In any case, the actual biopsy report is the most important one. (When my kids were diagnosed, I actually requested the images of the pathology slides and the pathologist was actually very happy to go over them with me). In addition to blunted villi, there has to be also a certain type of neutrophilic infiltrate (specific white blood cells in the lining) visible under the microscope. Misdiagnosis in particular when the pathologists are not experienced is quite common. For that reason, for diagnosis itself the blood tests are very important and possibly even more important than the biopsy (but prominent experts disagree on this). Even if the biopsy is negative and the blood tests are positive a gluten-free diet is recommended by most clinicians. The biopsy is most important in case follow up biopsies are performed to evaluate the healing (or lack thereof) the disease. Here is a paper that is a little hard to read but you can see in table 2 other conditions that can mimick celiac disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587842/ . That said, there are newer scopes that have a very high magnification and the resolution is constantly improving and it would not be inconceivable that sometimes soon villi could be seen. 

Are you a dentist or oral surgeon?  If yes, why is dentistry still separate from medical?  

Link to comment
Share on other sites
docaz Collaborator
1 minute ago, cyclinglady said:

Are you a dentist or oral surgeon?  If yes, why is dentistry still separate from medical?  

I just learned something from you and I looked it up. Indeed with the newer scopes that use a camera chip you can magnify enough to see the villi. In my practice, I use magnification but through a microscope and not endoscopes. 

I am an oral maxillofacial surgeon. I started my training in Germany before moving to the US and I went to a special double degree program to medical and dental school because in many countries they distinguish between oral surgery which is a specialty of dentistry and maxillofacial surgery which requires a dental and a medical degree.  In the US, some oral surgeons have a medical degree and some do not. I think that it makes a lot of sense for general dentistry to be a separate field from medicine because the knowledge and skills to be a trained clinician are different and the training is quite long as it is and there is no point in wasting time and resources to train someone for something that they will never use. As the two professions become more and more technically advanced and specialized, I think that they will stay separate. 

Link to comment
Share on other sites
cyclinglady Grand Master

@docaz

Thanks for the explanation!  

Link to comment
Share on other sites
  • 2 months later...
Kelly1920 Rookie

I had my diagnosis- Coeliac. Thank you to everyone who responded to my questions. I was diagnosed over the phone on that day and it felt a relief rather than a panic that I thought it might be. I’m now trying to change my lifestyle in lots of ways and making lots of mistakes. I hadn’t realised how “Eeyore” I had become. Feeling fatigued and miserable because of the symptoms had become a way of life almost- and I am now hoping I will move past it. 
 

Any tips or tricks I should know or things to avoid? 

Link to comment
Share on other sites
trents Grand Master

Some tips, Kelly:

1. Familiarize yourself with food industry terminology that can disguise the presence of wheat, barley and rye. For instance, "malt flavoring," "malt extract," "bulgur," "durum" and other wheat varieties. Be suspicious of food label allergen tipoffs to the likely presence of gluten like, "may contain wheat," "processed on the same equipment as wheat, tree nuts and soy," and so on. Even spices can contain wheat if used as a texturing agent. Almost all canned soups contain wheat starch as a thickener. Most soy sauce contains wheat, believe it or not. Read the labels if you don't believe me. Read all labels for store bought prepared foods!

2. Keep in mind that the goal is to not only eliminate macro sources of gluten but micro sources from cross contamination when non gluten foods come in contact with gluten foods on cooking surfaces and utensils.

3. Check for gluten in supplements and meds you use. Wheat starch can be used as a filler in pills.

4. Avoid eating out as much as possible. When you must eat out and there is not a gluten-free menu, order things that are by nature not going to come in contact with gluten such as a baked potato or a hard boiled egg or fresh fruit. Ask that meat and veggies be cooked in their own clean cookware. When eating out you must be assertive.

5. Focus on eating simple, basic foods that you prepare at home where you have total control over cross contamination. Fresh meat, fresh fruit, fresh vegies. Avoid prepared food products as much as possible. We are discovering that even prepared foods labeled "Gluten Free" may not be. When buying prepared foods look for the label "Certified Gluten Free" as opposed to "Gluten Free." Certified Gluten Free products are generally subject to stricter standards. 

6. Be aware that your Celiac Disease may have caused the development of other food allergies/intolerances. This is very common because of "leaky gut syndrome." Celiac Disease tends to produce a dysfunctional immune system that mistakenly identifies safe foods as invaders.

 

It can be overwhelming at first. Big learning curve. Hope this helps.

Link to comment
Share on other sites
Scott Adams Grand Master

This list is good for the USA, and good for most things in the UK. I think the biggest differences would be "flavorings" and "natural flavorings" which may be different there, as well as just "starch." In the USA starch is always corn starch, but in the UK can be wheat I believe:

This article is helpful as well:

 

Link to comment
Share on other sites

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

  • Celiac.com Sponsor (A19):



  • Member Statistics

    • Total Members
      125,728
    • Most Online (within 30 mins)
      7,748

    Jessmn
    Newest Member
    Jessmn
    Joined

  • Celiac.com Sponsor (A20):


  • Forum Statistics

    • Total Topics
      120.8k
    • Total Posts
      1m

  • Celiac.com Sponsor (A22):




  • Who's Online (See full list)

    • There are no registered users currently online

  • Celiac.com Sponsor (A21):



  • Upcoming Events

  • Posts

    • knitty kitty
      @jmiller93, Some of us are seronegative and don't test positive on tTg IgA tests.  Anemia, diabetes, and Thiamine deficiency can cause false negatives on Celiac panels.  Have you been checked for nutritional deficiencies?  Iron? Thiamine?  Vitamin B12?  Vitamin D?  Only one Celiac markers is needed to develop the active disease.   I agree a gluten free diet trial is worth a try.
    • knitty kitty
      @HWB, Have you been checked for SIBO?  Small Intestinal Bacterial Overgrowth will cause constipation and chemically breath.   The best way to get rid of SIBO is to go on a ketogenic/Paleo diet, like the Autoimmune Protocol Diet.  It starves out the carbohydrate loving bacteria and allows good bacteria to repopulate the small intestine.   The SIBO bacteria can communicate with the brain along the gut-brain axis, making you crave carbs, and in return, the SIBO bacteria can mess with your immune system by lowering inflammation and producing endorphins.  So, it's no wonder you feel better eating sugar.   I took high dose (500-1000 mg/day) Benfotiamine (Thiamine) which promotes intestinal healing and helps keep bacterial in check.  Thiamine and Benfotiamine are safe and nontoxic even in high doses.  High doses (500-1000 mg) every day are required to get results.  The body responds differently to high doses.  Got rid of my SIBO like this.  It was tough, but Celiac makes you stronger.
    • Wheatwacked
      Try whole milk yogurt.  I eat Stoneyfield vanilla.  Add fruit if you like.  Cultured Pasteurized Organic Whole Milk, Pectin, Vitamin D3. Live Active Cultures S. thermophilus, L. bulgaricus, Bifidobacterium BB-12®, L. acidophilus, L. paracasei and L. rhamnosus. Looking at the NO Fat Greek Yogurt, consider that to give the mouth feel of real yogurt ahd Manufacterers of no fat yogurt add various processed ingrediant that many Celiacs have digestive issues with such as gums.  Consider it processed food.  Fat is an important factor in our appestat to tell us we've eaten enough.  Remove fat and we eat more.  Compared to whole milk yogurt Chobani no fat greek yogurt has a cardboard mouth feel. Chobani no fat greek: Cultured Nonfat Milk, Cane Sugar, Black Cherries, Water, Fruit Pectin, Guar Gum, Natural Flavors, Cherry Juice Concentrate, Locust Bean Gum, Lemon Juice Concentrate. 6 Live and Active Cultures: S. Thermophilus, L. Bulgaricus, L. Acidophilus, Bifidus, L. Casei, and L. Rhamnosus Funny that since recommending low fat diets in the 1970's the US population has gone from 15% to 50% obese.
    • sh00148
      Just had my daughter diagnosed and am currently awaiting blood test results for my son. As well as many bowel issues, mostly loose stools with mucus and lots of gassy moments sometimes leading to leaning stool, he has recently soiled himself in his sleep twice. He has been toilet trained for a long time, but is not waking up with the poo. It’s not just a little, it’s a lot.    We have had to make an appointment re his blood test results next week so will find out if it is coeliac too but I’m just wondering whether anyone else has had this? Ive read online that it could mean he’s constipated, but he poos all the time and it’s often soft, never hard. 
    • captaincrab55
      I know this isn't an IBS Forum, but it looks like they may have cracked the code on treating it.  They think the new discovery may make it possible to treat other autoimmune diseases.  Even if they develop a treatment I think I would continue eating strict gluten-free, but it may allow me to eat out gluten-free without the fear of being glutened.  That would be especially helpful when traveling.   I hope you find this article as promising as I did.   https://www.msn.com/en-us/health/other/scientists-have-discovered-a-cause-of-inflammatory-bowel-disease-they-said-it-s-a-holy-grail-discovery-
×
×
  • Create New...