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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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      Based on those results alone, it’s not possible to say you have celiac disease. The test that is usually most specific for celiac, tTG-IgA, is negative in your results, and the endomysial antibody (EMA) is also negative, which generally argues against active celiac disease. However, your deamidated gliadin IgA is elevated, and your total IgA level is also high, which can sometimes affect how the other antibody tests behave. Another important factor is that you were reducing gluten before the test, which can lower antibody levels and make the results less reliable. Because of that, many doctors recommend a gluten challenge (eating gluten regularly for several weeks) before repeating blood tests or considering an endoscopy if symptoms and labs raise concern. It would be best to review these results with a gastroenterologist, who can interpret them in context and decide whether further testing is needed.
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