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Hi listmates,

Last week I had my first endoscopic biopsy since my diagnostic biopsy for celiac in 2001.
This time, the MD also biopsied a small area of inflammation in my stomach.
Here is the (edited) pathology report and comment, followed by my interpretation of it.
If anyone has their own follow-up experience and/or more insight and context to share before I have a follow-up appointment with the MD, please do! I will summarize.

FINAL MICROSCOPIC DIAGNOSIS:
A. Stomach, Body, Biopsy:
- ANTRAL MUCOSA WITH MILD REACTIVE GASTROPATHY.
- No intestinal metaplasia identified
- No Helicobacter pylori organisms identified
B. Duodenal Bulb, Duodenum Second Part, Biopsy:
- DUODENAL INTRAEPITHELIAL LYMPHOCYTOSIS. See comment.
Comment: The clinical history of celiac disease is noted. Histological sections show intraepithelial lymphocytosis, including the villous tips, with preservation of the villous architecture.
…
CLNINCAL FINDINGS…
R/O Helicobacter pylori.
R/O Celiac Sprues. (sic)

My interpretation:
I asked the MD whether he expected to find any evidence that I have celiac, as I have kept a strict GF diet with occasional and very unpleasant accidental exposures. The most recent was two months prior to this biopsy.
He said no, he did not expect to.
Immediately after I regained consciousness, he showed me the photo of the small area in the stomach he biopsied, and prescribed Pepcid AC, 20mg/day for two weeks. One of my questions will be, how he will know it made any difference? Clinical experience?
He also said there was no macroscopic evidence of celiac (i.e., the “scalloped villi” described by the first gastro who biopsied me, who was certain the biopsy would confirm this macro observation and show villous atrophy.)
Now, reading the lab report I am somewhat surprised that only two specimens were taken from the duodenum.
After reading more online about the diagnoses, I conclude:
1) that the antral mucosa with mild reactive gastropathy may or may not be related to my celiac, but may explain an occasional reaction (nausea, vomiting 2+ hours after eating) similar to a gluten exposure when I have been certain there was none, and
2) diagnosis of intraepithelial lymphocytosis means there are more such lymphocytes present than normal, but the note about villous architecture should be reassuring to me that the incidence of the lymphocytes is not so high as to cause damage to the crypts and tips. See https://www.ncbi.nlm.nih.gov/pubmed/22825364 <https://www.ncbi.nlm.nih.gov/pubmed/22825364>
Another question I’ll ask: Am I correct to interpret this comment as Type 1 on the Marsh Scale?

Jack






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