Biopsy results

[Olfy75]

Hello 👋🏻 everyone ☺️

can you please help me understand my recent biopsy? 
 

Although my vili look normal, there’s CD3 lymphocytes. There is not indication on numbers, just that they are probably within normal ranges.

Is it normal to find lymphocytes? Shouldn’t they have indicated numbers/quantity? 
 

I remember my bladder biopsy (which I didn’t have at the same hospital) was much more detailed …

any input or explanation is highly appreciated ☺️

thank you!

[Scott Adams]

Be sure to ask your doctor about this result, but CD3 lymphocytes are a type of immune cell that plays a role in the body's immune response. In the context of celiac disease, the presence of increased CD3 lymphocytes in the small intestine's lining is an indicator of inflammation, which is commonly associated with celiac disease.

In some cases, individuals with early or mild stages of celiac disease may have normal-appearing villi during endoscopy, but increased CD3 lymphocytes suggest ongoing immune activity and the potential for the development of celiac disease over time.

Did you get a blood test for celiac disease, which typically happens before an endoscopy? If so, can you share those results?

Also, were you eating gluten daily before all of the tests?

[Olfy75]

3 minutes ago, Scott Adams said:

Be sure to ask your doctor about this result, but CD3 lymphocytes are a type of immune cell that plays a role in the body's immune response. In the context of celiac disease, the presence of increased CD3 lymphocytes in the small intestine's lining is an indicator of inflammation, which is commonly associated with celiac disease.

In some cases, individuals with early or mild stages of celiac disease may have normal-appearing villi during endoscopy, but increased CD3 lymphocytes suggest ongoing immune activity and the potential for the development of celiac disease over time.

Did you get a blood test for celiac disease, which typically happens before an endoscopy? If so, can you share those results?

Also, were you eating gluten daily before all of the tests?

Hi Scott Adams thanks a lot for your answer.

yes I had the endoscopy because my test results were “inconclusive”, as one one value was elevated, also apparent the most non specific one.

these were the results:

TTG IgA 0.2 ELI U/ml  -reference

< 7.0 normal

7-10 equivocal 

> 10 positive

S-IgA (g/L) 1.16 g/L -Reference 0.41-3.49

ANTI GLIADIN IgA Ab 86.0 U/ml - reference < 7.0

Only the anti gliadin was positive both times I got tested one month apart.

Yes I made sure I was eating gluten the month before the endoscopy. Generally my gluten intake is very close to none (I have other autoimmune diseases and according to my urologist gluten is pro-inflammatory and I should limit it). But I made sure to have something with gluten every day prior the blood tests and biopsy. I hope it was enough.

My doctor who performed the biopsy said my results are “a puzzle”, the lymphocytes “normal” and that I should follow a low FODMAP (I already tried this…) diet as I probably have IBS and to take amytriptiline (tried it as well). 
And to get iron IV since I’m anemic and low in vit D. 
i’m still not well and I feel like I didn’t really get an answer. 
 

Any idea about what I should do?

thank you! 

[Scott Adams]

So if you've had two positive (your example is a very high positive result) for celiac disease, AND symptoms like low vitamin D and iron, AND the biopsy results that suggest possible celiac disease, then you most likely have celiac disease. Why your doctor does not want to diagnose it is a mystery to me, but the article below has more info about your blood test results, including:

Quote

The DGP-IgA test is considered to have high sensitivity and specificity. In general, the DGP-IgA test has been reported to have a sensitivity ranging from 75% to 95% and a specificity ranging from 90% to 100%. The DGP tests have been found to have a sensitivity of around 85-95% and a specificity of around 95-98%.

 

 

[knitty kitty]

@Olfy75,

Anemia can cause false negatives on Celiac blood tests.  Anemia affects red blood cell production and also white blood cell production.  Antibodies (like anti-gluten antibodies) are in the white blood cell classification.  

And Amitriptyline.  Amitriptyline suppresses the immune system.   

AMITRIPTYLINE USAGE EXACERBATES THE IMMUNE SUPPRESSION FOLLOWING BURN INJURY

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103308/

 

Have you been checked for Celiac genes? 

Edited July 24, 2023 by knitty kitty
Typo

[Olfy75]

On 7/24/2023 at 7:23 PM, Scott Adams said:

So if you've had two positive (your example is a very high positive results) for celiac disease, AND symptoms like low vitamin D and iron, AND the biopsy results that suggest possible celiac disease, then you most likely have celiac disease. Why your doctor does not want to diagnose it is a mystery to me, but the article below has more info about your blood test results, including:

 

 

Thank you 🙏🏻 Scott Adams. 
I don’t know honestly, also biopsy results are very different where I am from (much more accurate in a way). 
But I sent it all to my doctor in the States and I’m waiting for him to revert back … 

Will update on his opinion!

Thanks for the article as well; it seems like the gliadin test I am positive for, is no longer regarded as “important” at present (this is what also my doc in the States said) but rather considered a misleading finding in otherwise “healthy” people 🤷🏼‍♀️

[Olfy75]

On 7/25/2023 at 12:22 AM, knitty kitty said:

@Olfy75,

Anemia can cause false negatives on Celiac blood tests.  Anemia affects red blood cell production and also white blood cell production.  Antibodies (like anti-gluten antibodies) are in the white blood cell classification.  

And Amitriptyline.  Amitriptyline suppresses the immune system.   

AMITRIPTYLINE USAGE EXACERBATES THE IMMUNE SUPPRESSION FOLLOWING BURN INJURY

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103308/

 

Have you been checked for Celiac genes? 

Hi Knitty Kitty, thanks for sharing the info, I didn’t know about the link anemia - false negative results.

As for amitriptyline, it affects cytokines, and neuro transmitters, that’s why it’s widely used for anxiety but also for painful conditions (they regulate both immunity AND inflammation, aka pain). I have an autoimmune condition and was given this drug in the past (hated it, stopped taking it very soon). 
not even going to start it.

I’m actually considering genetic testing, just not sure where to get them from, at the moment. Tbh I do not “want” to be celiac, I just want to feel better (and have some coherent answers). 
 

[CAS7]

Just one item I wanted to add to the conversation here (apologies if it's been mentioned) is the "Marsh Score" from the intestinal biopsy. Which is a grading system used to define the level of injury to the villi that lines the intestinal wall. It gives the patient valuable insight on how far the damage has progressed.

https://surgpathcriteria.stanford.edu/gi/celiac-disease/marsh.html