What is Upper Endoscopy and Why Is Small Intestine Biopsy Recommended for Celiac Disease?

When undergoing an estimation for possible celiac disease or gluten sensitive enteropathy doctors commonly propose an upper endoscopy and small intestine biopsy. What that may mean or why it is recommended may not be clear to population who are facing the decision to experience the procedure themselves or to field their child to the exam.

Endoscopy in celiac: What is it and how is it done?

Microscope

The medical name for upper endoscopy is esophagogastroduodenoscopy or Egd for short. The endoscope is a thin flexible tube about the diameter of a fat pencil that has a video chip in the end and channels for flushing of water, suctioning of secretions and tube of instruments. It has dials that allow the tube to be turned up/down and right and left at the tip permitting it to be passed straight through the mouth, down the esophagus or feeding tube, into the stomach and then into the first part of the small intestine the duodenum, hence the name Egd.

Endoscopy in celiac: Do you feel it or remember it?

People undergoing the exam in the U.S. Typically are sedated with a medication. Medications similar to valium with good amnesia and relaxing follow called midazolam or versed combined with a narcotic like meperidine (demerol) or fentanyl are generally used. More recently a very short acting intravenous sedative, propofol (diprovan), may be administered for deep sedation or an intravenous form of normal anesthesia. Occasionally, commonly in very young children or population with severe lung problems, normal anesthesia is required. The exam is commonly not felt or remembered because of the medications.

Endoscopy in celiac: What is examined in celiac and how well can the lining be seen?

Celiac disease affects the upper portion of the small intestine, in the two sections known as the duodenum and jejunum. The exam of the small intestine is commonly exiguous to the first section termed the duodenum though occasionally the second section known as the jejunum may be reached especially when a longer endoscope is used. The resolution of video images are very high with the latest endoscopes and also may have a magnification and color dissimilarity mode to detect very subtle signs of damage of the small intestine.

Endoscopy in celiac: What are the typical findings?

The characteristic appearance of the surface of the small intestine in celiac disease contain superficial ulcerations that are generally linear, flattening of the folds, notching or scalloping of the folds and a mosaic like pattern. However, the surface may appear normal and only under exiguous exam of samples will the lining show signs of gluten caused injury.

Endoscopy in celiac: What are biopsies?

Samples of small intestine are obtained with biopsy pliers that consist of tiny jaws with cups that permit pinching off samples of the intestinal lining. This is painless and very safe. The samples are sent to a analysis lab in a preservative solution, processed, mounted on a microscope slide, and stained for exam under the microscope by a pathologist. Small intestine injury from gluten may be patchy, therefore, some samples are recommended. A minimum of 4 pieces and preferably 8-12 samples should be obtained to avoid missing exiguous signs of celiac disease.

Endoscopy in celiac: What does the pathologist look for on the slides?

The pathologist examines the slide for evidence of damage or injury characteristic of gluten sensitivity. Occasionally special stains are required to see signs of irritation known as inflammation characterized by an increased amount of a type of immune active white blood cells called lymphocytes. In early celiac and gluten sensitivity without celiac disease the biopsy may be normal and the analysis cannot be established by the biopsy.

Endoscopy in celiac: Summary.

The procedure of endoscopy is safe, painless, and very helpful for establishing the analysis of celiac disease while excluding other upper intestinal disorders. The main drawback of endoscopy is that nearly everybody must have sedation to tolerate the exam and it can be expensive if not fully covered by insurance. Sometimes, celiac disease is diagnosed by endoscopic biopsy in population who whether have normal blood tests or as an incidental looking in those undergoing endoscopy for other reasons. Fear or obscuring about endoscopy should not forestall anything who is suspected of having celiac or gluten sensitivity from undergoing endoscopy. Added facts about celiac disease and other digestive diseases are ready at http://www.thefooddoc.com, the premier website under improvement by "the food doc", Dr. Scot Lewey, a practicing stomach and intestinal devotee (gastroenterologist).

Copyright 2006, The Food Doc, Llc All possession Reserved. Http://www.thefooddoc.com

What is Upper Endoscopy and Why Is Small Intestine Biopsy Recommended for Celiac Disease?

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Celiac Disease Biopsy Explained: Part I Villous Atrophy

The diagnosis of celiac disease is confirmed by a characteristic abnormal appearance of the small intestine under the microscope. Flattening of the general finger like projections called villi accompanied by signs of inflammation is taken to indicate damage or injury from the storage protein gluten in wheat and similar proteins in barley and rye. The small intestine biopsy has became the gold thorough for establishing the diagnosis of Celiac disease or gluten sensitive enteropathy. Before 1960 gluten retirement followed by improvement and subsequent worsening upon rechallenge was the diagnostic criteria.

Early in the 1960's through the 1970's the small intestine was biopsied by having people swallow a small metal capsule that was attached to a suction tube. This was used to suction up tissue into the capsule before guillotining off some tissue once the capsule was confirmed to be in the small intestine by x-ray. Now the tissue is obtained by upper endoscopy, the duct of a lighted video scope through the mouth under sedation to the small intestine, where biopsies are obtained with cupped forceps.

Microscope

Celiac disease biopsy: What does the pathologist look for under the microscope?

The small intestine regularly has finger like projections called villi that give it a large face area or experience area for absorption. The villi effect in a shag rug or terry cloth towel type appearance. Lining the face face of each villous are intestinal cells or enterocytes that secrete mucus and discharge fluids, nutrients, minerals like iron, and vitamins like B12. On the face of the enterocytes are digestive enzymes like lactase that discharge lactose or milk sugar. At the base of the villi are crypts or circular like collections of intestinal cells.

Celiac disease biopsy: What is villous atrophy?

Normally, villi are 3-5 times longer than the crypts are tall. However, intestinal injury can effect in blunting, shortening (partial villous atrophy) or faultless loss of the villi and flattening (villous atrophy) of the intestinal surface. The shag rug will have bare spots or the terry cloth towel becomes like a tee shirt. The effect is lack of absorption of nutrients and water resulting in weight loss, malnutrition, and diarrhea.

Celiac disease biopsy: What if the biopsy does not show atrophy or partial atrophy?

If the villi are at least 3 times as long as the crypts are tall then no flattening or blunting of the villi is present and celiac disease becomes more difficult for the pathologist to diagnose without the history or blood test results. However, an increased amount of Iel's (intra-epitheliel lymphocytes) in the setting of a definite definite blood test for celiac, symptoms and especially if supported by presence of Dq2 and/or Dq8 gene pattern, is highly suggestive of celiac disease. The mystery comes when the blood tests for the definite tests are negative or not elevated but only the "non-specific" blood tests (anti-gliadin or Aga and anti-reticulin antibodies) are elevated. Also, some people with milder forms of celiac have no blood tests abnormal but have first-rate biopsy findings of celiac and are termed seronegative (blood test negative) celiacs.

Celiac disease biopsy: Can the biopsy be general in celiac disease?

By definition, the biopsy has been determined the gold thorough for diagnosing celiac. However, modern studies have shown that the biopsy can be general in some people with celiac. How can this be? The pathologist reading the biopsy may account for the biopsy as general based on his or her bias about celiac disease, a failure to appreciate the point of the presence of Iel's, or misuse of the older thorough of >40 Iel's per 100. However, more importantly is the modern recognition that general appearing biopsies may not be normal. Electron microscopy has revealed ultra-structural abnormalities in apparent general biopsies of people confirmed to have celiac disease. Special stains, that contain immune labeling of lymphocytes, have also confirmed increased numbers of definite types of definite lymphocytes in the villi of intestinal biopsies of people confirmed to have celiac. The lowest line is that a general biopsy does not definitively exclude celiac disease or gluten sensitivity.

Celiac diasease biopsy: What are other inherent causes of biopsy changes that mimic celiac disease?

Cow's milk protein sensitive enteropathy (Cmse), viral or bacterial infections, medications (especially aspirin like arthritis medications e.g. Ibuprofen etc), autoimmune enteropathy, Helicobacter pylori infection (the stomach ulcer bacteria), Aids, coarse variable immunodeficiency, and lymphoma of the intestine are all inherent causes of small intestine changes that may mimic celiac. However, if you have first-rate celiac type symptoms, a definite celiac definite antibody (anti-endomysial antibody or tissue transglutaminase antibody) and a definite response to a gluten free diet then celiac is the likely cause. The likelihood is further increased if you carry one or both of the two major genes associated with celiac disease, Dq2 and/or Dq8. Normalization of celiac definite blood tests and the biopsy after a gluten free diet confirms the diagnosis of celiac disease.

Celiac Disease Biopsy Explained: Part I Villous Atrophy

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