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

The following post was on the list.  As a physician I have some opinions
about this I wish to share.

Last part first.  An EGD is not very invasive of a test. The endoscope goes
down the esophagus just where food goes.  No incision is needed.  With
adults a sedative is used.  Usually patients don't go fully asleep,
though they think they have because there is a forgetfullness about the
procedure caused by the sedative.  In children a stronger sedative is
used, such as ketamine and midazolam (Versed) in combination.  Very nice
sedation, short action, just right for the 5 to 10 minutes the procedure
takes.

Negative biopsies with positive antibodies generally should be considered
as evidence that celiac disease is not present.  False positive antibody
tests are not uncommon, especially when low titer.  However, a negative
biopsy does not mean the patient is not gluten intolerant.  It means the
intestine is not suffering from immune attack upon it.  A number of patients
with digestive problems that are hard to diagnose find certain foods are
bothersome.  Eggs, soy, corn, wheat, pork and beef are the most common
isolated intolerances, usually just one.  Wheat intolerance is not Celiac.

My view is that the tests each show something different about the patient.
A response to a gluten challenge and rechallenge shows symptoms related to
gluten.  A biopsy shows a cellular immune response in the intestinal surface.
Antibodies show an immune response by the antibody system (except for some
low titer false positives that are just sticky serum).

Recommendations that I give patients are that if the intestinal tissues
are normal on biopsy then gluten needs to be restricted to eliminate
symptoms.  If the biopsy is positive then gluten needs to be completely
eliminated even if partial restriction makes the patient asymptomatic.
If antibodies are high titer I want the patient off gluten so that the
antibodies normalize and stay negative.

The reason for the biopsy is to make recommendations on life long treatment.
A 10 minute EGD is nothing compared to a lifetime of treatment.

Stephen Holland, M.D.
Naperville Gastroenterology
www.napervillegi.com


>I need to know if the other celiacs of the group are willing to share =
>with me how many of them had biopsies that were negative.  Long story =
>but it has to do with the custody hearing we are dealing with. My ex has =
>decided to get a biopsy done on ***** in order to prove to ME that she =
>does NOT have celiac disease.  THe biopsy does not bother me so much as =
>the fact that a) he didn't consult me before hand and b) that I have =
>heard of others having biopsies that were negative even after blood work =
>that indicated a need for them.
>I can't say the biopsy doesn't bother me.....it seems awfully invasive =
>to me for a  9 year old to have to undergo, especially when this Dr.  =
>says she doesn't need it anyway, but because my ex told her *I* needed =
>proof she will do it anyway.

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