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Better biopsy practices could aid celiac disease diagnosis

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Celiac Disease related image Photo: Getty Images

If you worry that you might be gluten sensitive or perhaps even have celiac disease, then your doctor might conduct one of several tests: a blood test to look for gluten antibodies and vitamin and mineral deficiencies; a stool test to check for malabsorption; an endoscopy through the throat to examine the intestine; or a biopsy of the small intestine to check for inflammation and tissue damage.

If you undergo that last diagnostic test, you might want to be aware of recent criticism that such biopsies are usually not thorough enough. A study published in the July 2011 issue of Gastrointestinal Endoscopy said, the majority of patients do not undergo the recommended four biopsies of tissue samples, which possibly shortchanges them from a timely diagnosis and a solution to their digestive problems.

Researchers used a national database of biopsy specimens from Caris Life Sciences in Irving, Texas, giving them access to more than 100,000 patients who had had a biopsy of the small intestine. Only 35 percent of the patients had four tissue samples taken; in most cases the patients had two samples taken.

“Celiac disease can affect the small intestine in a patchy distribution, and so just one or two biopsy samples could potentially miss the evidence of the disease,” the study’s lead author, Dr. Benjamin Lebwohl, said in the July 6, 2011, ScienceDaily.

Lebwohl, a gastroenterologist at the Celiac Disease Center at Columbia University Medical Center in New York, was part of a team who studied the celiac disease diagnosis rate among patients who had submitted four specimens and compared that to the diagnosis rate when fewer specimens were involved. Adhering to the professional guideline, four specimens more than doubled the rate of diagnosis of celiac disease.

Even though a biopsy is more invasive than other diagnostic tools for celiac disease, the process of taking four samples instead of two requires only an extra minute during endoscopy, said Lebwohl.

Another point of criticism in the study was that even among doctors who suspected celiac disease in their patients because of, say, a positive blood test, there was still a low rate of adhering to biopsy guidelines. When these doctors did take four samples, the rate of diagnosis increased sevenfold.

Dr. Peter Green, director of the Celiac Disease Center, said, “In this study, we identified just one of the factors contributing to the high rate of under-diagnosis of celiac disease in the United States.” Green added that future studies will look at other physician-related factors.





Reviewed July 28, 2011
by Michele Blacksberg R.N.
Edited by Shannon Koehle

Add a Comment2 Comments

EmpowHER Guest

Just to clarify, the endoscopy and biopsy are really the same diagnostic tool. No physician looking for celiac disease would undertake the invasive endoscopy procedure without also taking biopsy samples, even if they take too few samples, as this study suggests. Biopsies are taken during the endoscopy procedure.
That being said, it is shameful that some physicians are not taking the recommended 4-6 biopsies while the patient is already sedated and they are already performing the endoscopy/biopsy procedure. Hopefully, the release of this study will educate them on the very real need to take 4-6 biopsies in order to more accurately diagnose celiac disease.
~jules shepard

July 28, 2011 - 7:44am
(reply to Anonymous)

Thanks for the clarification. As you noted, better practices with biopsy samples might address the under-diagnosis issue.

July 29, 2011 - 9:25am
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