Biopsy Results - Please Interpret If You Are Able!

[Elisec5678]

Hello!

I tested positive for Celiac Disease via a blood test almost 2 weeks ago. My Tissue Transglutaminase Antibody, IgA was 64 U/mL (standard range is 0.0 - 6.9 U/mL) and was interpreted as positive.

I just had an endoscopy about 5 days ago and just received the results. Can someone please help me interpret these, primarily the severity of celiac?

Here is exactly how they appear (everything in quotations):

 

"FINAL DIAGNOSIS

Duodenum, biopsy:

 - Villous atrophy, near total, and intraepithelial lymphocytosis consistent with celiac disease in the proper clinical setting

 

Clinical Information

TTG abnormal

 

Microscopic Description

Microscopic examination is performed.

 

Gross Description

A:

 - The specimen is received in formalin and labeled with the patient's name and "Duodenum".  The specimen consists of multiple tan-white irregular soft tissue fragments, averaging 0.2 cm. The specimen is filtered and entirely submitted in one cassette. AW"

 

Thank you!

[trents]

Elisec5678, welcome to the forum!

Yes, your tTG-IGA at 64 is clearly positive.

Concerning the biopsy report, celiac disease is an autoimmune disorder that causes inflammation in the lining of the small bowel when gluten is ingested. This lining consists of a landscape of tiny finger-like protrusions that create an extensive surface area for absorbing the nutrients from our food, such as vitamins and minerals. These projections are called "villi". In the celiac population, the constant inflammation from gluten ingestion causes damage to the villi, blunting or rounding them off such that we lose surface area for nutrient absorption. Thus, nutrient absorption becomes less and less efficient, resulting in various nutritional deficiency diseases, even though we may be eating well.

Your report indicates that you have suffered from undiagnosed celiac disease for a long time, such that your villous lining is almost completely destroyed. With diligence in gluten free eating it will likely be restored in around two years, depending on your age and other factors.

Is this helpful or do you have other questions?

[yuluyouyue]

  On 9/26/2022 at 5:02 PM, Elisec5678 said:

Hello!

I tested positive for Celiac Disease via a blood test almost 2 weeks ago. My Tissue Transglutaminase Antibody, IgA was 64 U/mL (standard range is 0.0 - 6.9 U/mL) and was interpreted as positive.

I just had an endoscopy about 5 days ago and just received the results. Can someone please help me interpret these, primarily the severity of celiac?

Here is exactly how they appear (everything in quotations):

 

"FINAL DIAGNOSIS

Duodenum, biopsy:

 - Villous atrophy, near total, and intraepithelial lymphocytosis consistent with celiac disease in the proper clinical setting

 

Clinical Information

TTG abnormal

 

Microscopic Description

Microscopic examination is performed.

 

Gross Description

A:

 - The specimen is received in formalin and labeled with the patient's name and "Duodenum".  The specimen consists of multiple tan-white irregular soft tissue fragments, averaging 0.2 cm. The specimen is filtered and entirely submitted in one cassette. AW"

 

Thank you!

Expand Quote  

Hello. Almost the same description was on my biopsy report. Plus it also said it was Marsh 3 damage which is almost total damage. But don't let this discourage you. Your villi will heal on gluten free diet and then your starting point won't matter, ie. you will be no different than someone who had mild damage at diagnosis. 

[Elisec5678]

Thank you both so much for your responses - both very helpful!! Much appreciated. 
 

Do these biopsy results mean I have to be more careful about cross contamination, etc. than others? Or anything else I should know about them?

Also, I have a very high PTH value and low bone density and I am 26 years old. Should I expect these to improve on gluten free diet?

Thanks again for the help!!

[trents]

Bone remineralization should happen at your age I would think if you maintain a strict gluten-free diet. It would also be important in that regard for you to begin some serious vitamin and mineral supplementation. Make sure you purchase vitamin and mineral products that are certified gluten-free as wheat starch can be used as a filler in pills. Costco's Nature Made and Kirkland Signature brands are good choices and will state clearly on the label if they are gluten free. I would recommend adult multi vit (like Centrum), a high potency B-complex, 5000IU of D3 and either Magnesium citrate or Magnesium glycinate (these two forms are well-assimilated comparted to the less expensive and more common magnesium oxide). Start with a small dose and titrate up on the magnesium supplement until you reach the point where it is causing loose stools (think, "Milk of Magnesia) and then cut back a tad. Magnesium and D3 are very important to bone health. Don't worry about B-vitamin toxicity. They are water soluble and you will pee out any excess. I would avoid excessive calcium supplementation as it can change gut PH and be counter productive. Your problem isn't insufficient dietary calcium but rather poor assimilation because of villi blunting.

The biopsy results are not an indicator of how sensitive you are to gluten but rather how long you have been living with celiac disease. I cannot emphasize more strongly that you need to take CC (cross contamination seriously. That doesn't mean you have to become obsessive compulsive about it but it does mean you can't be lazy about it or take anything for granted. Don't necessarily rely on gut discomfort as an indicator of being "glutened". Small amounts of gluten can create inflammation in the small bowel lining that you are unaware of and sabotage healing.

Learning to eat gluten-free is more of a challenge than most people imagine at the outset. There is much to learn about how gluten is deployed and hidden in processed foods by the food industry (terminology) and then there is the whole issue of cross contamination. It's easy to eliminate the major sources of gluten in our lives but harder to eat truly gluten-free. Perhaps this will help you get started: 

It takes a year or two to get really savvy about avoiding gluten but with time you sort of develop a sixth sense about it.

Be aware also that the dairy protein casein can cause villi blunting in some celiacs just like gluten and many celiacs are also lactose intolerant. About 10% of celiacs react to the oat protein avenin like they do gluten. So if avoiding gluten doesn't relive your symptoms like you expect, look at these other things.