Celiac Disease Biopsy

In the past years the “gold standard” for diagnosing Celiac Disease was a small bowel biopsy during an endoscopy (small bowel is another term for small intestine.) Small bowel biopsies in prior decades been the only way to positively confirm the diagnosis of Celiac Disease, even when blood tests have confirmed a positive finding. The problem with this procedure has been that unless complete (Stage 4) villous atrophy was shown, the earlier stages of this autoimmune disease were missed. In the more recent years, more advanced blood and saliva testing have been shown to be just as reliable as a biopsy. In many cases today, confirming Celiac Disease with an invasive biopsy will only have a negative impact on the cost of health and life insurance.

 

Ordinarily, the lining of the small intestine (the mucosa) is covered with hairlike projections called villi (picture a tube with a shag carpet lining). In patients with untreated Celiac Disease, the inflammation that develops in response to gluten causes the villi to shrink and flatten. This effect can be seen when tissue samples taken from the small intestine by biopsy are examined under a microscope.

 

While the patient is asleep, the doctor passes a long, narrow tube called an endoscope through the patient’s mouth and stomach, into the small intestine. The doctor can then pass instruments through the endoscope to remove tissue samples and also to take photographs. Later, a pathologist will study the tissue samples to check for the classic signs of shrinkage and flattening of the villi. Celiac Disease is then diagnosed when “full villous atrophy” is confirmed through the biopsy.

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