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Do these biopsy results look like Celiac?


JenniK

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JenniK Contributor

I had an endoscopy and colonoscopy recently for chronic upper abdominal pain, which i thought was an ulcer, but they didn’t find one. I have been gluten-free for 3 or so (?) years now with presumed celiac. Gastroenterologist told me before procedures that he cannot (most likely) diagnose celiac because i was gluten-free for long time before seeing him. These results were posted by the pathologist, but I still haven’t had the Dr explain to me what he thinks. There seem to be several problem areas. Keep in mind that i was not knowingly eating gluten before endoscopy. A-C are gastric. D,E are colon. (A different part of the report also said “diffuse inflammation” and “reactive gastritis”. Thanks in advance

A. Fragments of small intestinal mucosa show normal villous architecture without intraepithelial lymphocytosis. A normal complement of
chronic inflammatory cells is present in the lamina propria without acute or granulomatous inflammation. runner's glands are present.
There is no metaplastic change, dysplasia, or malignancy.
B. Fragments of gastric antral and oxyntic mucosa show foveolar hyperplasia and smooth muscle hypertrophy and few foci of chronic
inflammatory cells within the lamina propria without acute or granulomatous inflammation. There is no intestinal metaplasia, dysplasia, or
malignancy. Features typical of Helicobacter pylori are not seen.
C. The sections show oxyntic type gastric mucosa with normal surface maturation and rare cystically dilated crypt lined by foveolar
epithelium. Normal minimal inflammatory infiltrates are present within the lamina propria. Acute or granulomatous inflammation is not
identified. Features of Helicobacter gastritis are not identified. Intestinal metaplasia, dysplasia, or malignancy are not identified.
imer
D. E. Colonic mucosa shows crypt hyperchromasia with elongation and pseudostratification of the nuclei. Features of high-grade
dysplasia are not identified.
Unless otherwise specified, formalin-fixed paraffin-embedded sections and all routine, IHC, or special stains are performed at


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Scott Adams Grand Master

The results seem negative for celiac disease, but I would agree with your doctor here with their conclusion that the results could not be used to diagnose celiac disease since you were gluten-free for so long before the endoscopy. 

Given that you've been gluten-free for so long, how important is it to you to have a formal diagnosis? Your private life and/or health insurance premiums my go higher with a diagnosis, so keep this in mind.

You could do this again after going at least two weeks on a gluten diet where you eat 2 slices of wheat bread daily beforehand. 

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      Hi Florence, thank you for clarifying — and no worries at all about late-night writing. I appreciate you explaining that you’re specifically asking about gluten cross-reactivity, particularly the proposed immune cross-reaction between alpha-gliadin and certain non-gluten foods on a gluten-free diet. It’s an interesting and often confusing topic. The Vojdani & Tarash paper you mentioned did report antibody cross-reactivity in laboratory settings, which has led to a lot of discussion in the gluten-free community. However, it’s important to note that in-vitro antibody reactions (in a lab dish) don’t always translate into clinically meaningful reactions inside the human body. At this point, major celiac research centers generally conclude that true immune cross-reactivity to non-gluten foods in people with celiac disease hasn’t been clearly demonstrated in well-controlled human studies. That said, many individuals do report symptoms with foods like corn, dairy, oats, or others, and those reactions can absolutely be real — they just may involve different mechanisms, such as food intolerance, FODMAP sensitivity, separate immune responses, or individual gut permeability differences rather than molecular mimicry of gliadin specifically. If certain foods consistently trigger symptoms for you, keeping a structured food and symptom log and discussing it with a knowledgeable gastroenterologist or dietitian may help clarify patterns. It’s a nuanced area, and your question is thoughtful — we just have to separate what’s biologically plausible in theory from what’s been conclusively demonstrated in patients.
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