How long of a gluten challenge for Endoscopy?

[akacase]

Hi Folks,

Type 1 diabetic here; I got diagnosed almost 8 years ago and have been pretty strict gluten-free since, but since reviewing labs from that time. In the last few years, my doctor said the test wasn't conclusive (blood test) as my tTG-IgA was 4 (reference range 4-10 is a weak positive from our lab); all other values were normal. I had no symptoms and still don't. If I accidentally eat something with gluten, all celiac panels yearly show up as unfavorable (eating gluten-free). I have the gene for celiac, and my mother and grandmother both have the disease. I had an endoscopy that was for a gallbladder-related issue (which ended in a cholecystectomy), and that was over two years ago. The Dr. had me do a gluten challenge for only a week to state that he didn't believe I was celiac, which I didn't think, so I continued with gluten-free, but my GP would like a conclusive diagnosis, which I'm OK with, but I'd like some advice on how long to eat gluten for? How much? Is sourdough and naturally leavened bread OK? Below is the original comment from my biopsy, which was a 7-day challenge, where I ate at least two pieces of toast every morning for breakfast, sometimes a bit more throughout the day:

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On part A, the duodenal biopsy shows normal villous architecture and focal mild increase in intraepithelial lymphocytes. The findings are of unclear clinical significance and may be incidental. The possibility of celiac disease, however, cannot entirely be excluded. Correlation with clinical and serologic findings is necessary. Other considerations that can present with similar histologic findings include dermatitis herpetiformis, systemic autoimmune/immunodeficiency disorders, drugs (particularly NSAIDs), inflammatory bowel disease, H. pylori gastritis, peptic duodenitis, infections, tropical sprue, and spontaneous bacterial overgrowth.

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After that test, it did indeed turn out that I had a massive H. Pylori infection, as well as a shot gallbladder, which could corroborate the findings. I guess I'm asking how I should proceed with this challenge. I'd like to know for sure. My other siblings do not have celiac, but they also are Type 1 (yay). It's not like I want to go out and feast on gluten; I'm over it, but it would be nice not to worry about eating out.

If I do the test, there's a wonderful local bakery that makes naturally-leavened bread, which I'd like to eat mostly, but I'm scared of a negative screen because of sourdough. Is around three weeks fine? My new endoscopy is on January 2nd.

Thanks for reading!

[trents]

Welcome to the forum, @akacase!

Recommendations from the medical community with regard to the gluten challenge are in flux lately and you will see a range of advice with regard to how much gluten and for how long. The general consensus, however, is that historically, guidelines were too relaxed and the trend in recommendations is for eating a higher amount of gluten daily over a shorter amount of time. Here is what I would advise as I have interacted with various guidelines: at least 10g of gluten daily for at least four weeks leading up to the day of the test, either the serum antibody blood draw or the endoscopy/biopsy. 10g of gluten is the amount in approximately 4-6 slices of wheat bread. Sourdough bread is much lower in gluten so that should not be used for a gluten challenge.

By the way, you speak of having "the celiac gene". There are actually two main genes (HLDQ2 and HLDQ8) and their variants that have been associated with the potential to develop active celiac disease.

You might consider also that instead of having celiac disease you have NCGS (Non Celiac Gluten Sensitivity). NCGS shares many of the same symptoms of celiac disease but does not damage the lining of the small bowel as does celiac disease. There is no test for it. A diagnosis for NCGS depends on first ruling out celiac disease. It is 10x more common than celiac disease. Some experts feel it can be a precursor to the development of celiac disease. Eliminating gluten from your life is the antidote for both.

Edited December 10, 2024 by trents

[Scott Adams]

I agree with @trents on the sourdough bread--regular bread should be used, or Saltine crackers, etc.