If antibody tests and/or symptoms suggest celiac disease, a physician should establish the diagnosis by obtaining tiny pieces of tissue from the small intestine to check for damage to the villi. This is done via endoscopic biopsy. Under sedation, the physician eases a long, thin tube called an endoscope through the mouth and stomach into… Read more »
(Updated .)Keyword: biopsy
Are biopsies of the small intestine conclusive?
Generally, antibody blood tests and biopsies are sensitive and specific enough to clearly diagnosis celiac disease. However, because no test is perfect, a firm diagnosis should include antibody blood screening, biopsies and response to a gluten-free diet. Although biopsies are the standard for diagnosis, periodically they do not lead to a clear diagnosis. Many factors… Read more »
(Updated .)Is a colonoscopy better than an endoscopy for taking biopsies of the small intestine?
You can approach the small intestine through either end, though it is more common to obtain biopsies through endoscopy than colonoscopy. As long as the biopsies are of the small intestine then they can be taken either way. Biopsies from the ileum obtained during a colonoscopy may show the villus blunting typical of celiac, but… Read more »
(Updated .)Are family history and genetics important in diagnosing celiac disease? And, if so, how should I decide whether to have a biopsy?
Family history and genetics are important, but they don’t determine whether an endoscopic biopsy should occur. They merely help you determine whether you’re in an at-risk group, or not. Read our “Diagnosis of Celiac Disease” Factsheet to learn more.
(Updated .)I’m concerned about my child having a biopsy. Is it really necessary in children? Can my child have the biopsy when he is older?
While it is understandable for parents to be concerned about this procedure, there are several important facts to consider. First, the procedure takes 10-15 minutes, during which the child is under general anesthesia and closely monitored by a team of anesthesiologists and an experienced physician. Second, research shows that children diagnosed before the age of… Read more »
(Updated .)How do you get a doctor to perform a biopsy when the blood test is negative?
Guidelines may or may not be followed; it all depends on the physician’s judgment in each individual case. Most doctors won’t do a biopsy with a negative test because the test is about 98% accurate. However, by definition, 2% of those with celiac disease do have a negative test, so experienced physicians must handle each… Read more »
(Updated .)How much gluten should be consumed prior to being screened for celiac disease?
It’s best to continue a normal, gluten-containing diet before being screened and diagnosed. If a gluten-free diet has been followed for more than a few weeks, then we recommend eating at least 1 serving of gluten (1/2 slice of bread or a cracker, for example) every day for 12 weeks prior to a blood test… Read more »
(Updated .)Will the biopsy continue to be the gold standard for diagnosis?
It’s very likely that the biopsy will remain the gold standard for years to come; approximately 90% of new cases are diagnosed using an endoscopic biopsy as part of the diagnosis. Only in rare cases is a diagnosis made without a biopsy as part of the diagnosis. In these rare cases a patient must have at least… Read more »
(Updated .)What do you recommend for patients with seronegative celiac disease? Do you repeat the scope to ensure that someone is truly gluten free?
For the rare celiac with negative antibodies there is no test other than repeating the biopsy to ascertain full recovery. However, you can assess remission if everything is perfectly fine clinically. In other words, if the symptoms that were present prior to a gluten-free diet have not returned, you may be able to assume the… Read more »
(Updated .)Can you confirm celiac disease from only a blood test?
Never, in fact. Other variables must be part of a diagnosis. New guidelines in 2011 allow for diagnosis without a biopsy, but only in very rare cases. In these rare cases at least one of the genes must be present, both tTG and EMA blood tests must be more than 10x normal, and there must… Read more »
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