<<Disclaimer: Verify this information before applying it to your situation.>>

What to do with a negative biopsy is a common issue that comes up on
the list.  One of the issues that contributes to this is that many
gastroenterologists conclude there is no problem with wheat if a biopsy
comes back negative.  This is an incomplete view for several reasons.

- Biopsies may be misread by the pathologist, either due to orientation
of the biopsy on the cuts or from not calling abnormal specimens that
are not classic in appearance.
- The biopsies may not be from the right area of the duodenum.
- There may not have been enough pieces submitted.
- The patient may not have been on gluten long enough.
- The patient may not tolerate wheat for reasons other than celiac
disease.

The last is an issue that many forget.  It is possible to have a food
allergy and not have celiac disease.  Food intolerance to soy, corn,
pork, beef, and eggs are pretty common.  One can be intolerant to wheat
as well, but just not be celiac.

If a patient is biopsy negative (with the caveats above recognized) and
serology negative (and not IgA deficient) then the patient is not
celiac.  The person may still be better off wheat, but there is not the
risk of other autoimmune disease, lymphoma, osteopenia, and
malnutrition that is present in patients with Celiac disease.

I advise such patients to reduce wheat to eliminate symptoms, in
contrast to celiac patients, who need complete elimination of wheat
from the diet and medical followup.

More to the point of the question asked by the poster, if a question
exists to the diagnosis the first step would be to review the original
slides from all the biopsies.  Check HLA-D type, and, If questions
still exist, go back on gluten for a month to get symptoms and redraw
serology and redo the biopsy.

This problem comes up so much in patients diagnosed with possible
celiac disease, that good biopsies and blood tests are recommended so
that confusion that there is no confusion later on the strength of the
diagnosis.  It is unfortunate to have to do a gluten challenge when the
full diagnostic studies could have been done initially.

Stephen Holland, M.D.



On Thursday, October 2, 2003, at 11:00  PM, Automatic digest processor
wrote:

> Date:    Thu, 2 Oct 2003 16:23:22 -0400
> From:    Mary <[log in to unmask]>
> Subject: biopsy negative
>
> Hello everyone...I am newish here and would like to ask advice.  I
> found
> this great site after being initially diagnosed with Celiac by a
> hematologist with the blood test in August.  From there, I was sent to
> a
> gastroenterologist who preformed an endoscope last week.  After the
> procedure, he said I have gastritis and a hiatal hernia and that the
> villi
> looked somewhat flatten upon examination but not completely.  He just
> called
> me and told me that the biopsies came back negative for sprue.  I was
> somewhat relieved when he was saying that and from here he suggest
> stool
> tests and a colonoscopy.
>
> I have a very long history of diarrhea (20 years) and when I tried to
> find
> out what was wrong in the mid-80's, the tests came back
> inconclusive...they
> said it was irritable bowel.  So I just lived with it all these years.
>  I
> now am having some other medical problems and upon meeting the
> hematologist
> for an anemia problem, he said after taking my history, I think you
> have
> sprue.  And that's where this all started. (some other medical
> probelms I am
> having are also relatable to this he felt)
>
> So.. I guess what I am asking you (so sorry for being so winded here)
> is
> this....is it possible to have the blood test positive but the biopsy
> negative and still have Celiac?  Any suggestions/input anyone would
> like to
> share with me would be greatly appreciated.
>
> Thank you very much.
> Mary

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