| In this article, further detail is provided regarding | | | | people with normal blood tests and normal |
| the appearance of the intestine under the | | | | intestinal biopsies. If celiac blood tests are negative |
| microscope in celiac disease and gluten sensitivity. | | | | or normal then the biopsy is usually normal. |
| The terms intra-epithelial lymphocytosis and crypt | | | | However, this is not always the case and some |
| hyperplasia are defined and explained for those | | | | people with true celiac disease have a classic |
| wanting to know what doctors are looking for | | | | biopsy for celiac with normal blood tests. |
| when a biopsy of the small intestine is | | | | Moreover, early celiac disease is characterized by |
| recommended during the evaluation of possible | | | | more subtle changes on biopsy and in this setting |
| celiac disease. | | | | the blood tests are usually negative. Furthermore, |
| Celiac disease biopsy: What is crypt hyperplasia | | | | some biopsies may look normal under the |
| and intra-epithelial lymphocytosis? | | | | microscope but with special stains or electron |
| The crypts can become enlarged (crypt | | | | microscopy are not normal and show signs of |
| hyperplasia) in response to stimulus of injury or | | | | gluten sensitivity or injury. |
| perceived threat of invasion to the body. White | | | | These people may be early celiacs and are usually |
| blood cells called lymphocytes are activated and | | | | gluten sensitive. Therefore, we are sometimes |
| sent up from the crypt areas to the tips of the | | | | left with a semantics problem. Gluten sensitivity |
| villi. This results in what is termed intra-epithelial | | | | with normal blood tests and biopsies that |
| lymphocytosis or increased intra-epithelial | | | | responds to a gluten free diet is well recognized. |
| lymphocytes (IELs). This is the hallmark of celiac | | | | However, a clear-cut definition for this is not |
| disease and the earliest sign of gluten sensitivity. | | | | widely accepted. Some people labeled as gluten |
| It is not however specific for celiac disease or | | | | sensitive are people who have early celiac disease |
| gluten sensitivity. | | | | where not enough injury of their intestine has |
| Celiac disease biopsy: What is considered a normal | | | | occurred to result in elevated or positive blood |
| number of IELs? | | | | tests and/or they don't have characteristic |
| Over 30 years ago the standard cutoff for IELs | | | | changes of injury from gluten on their small |
| was 40 per 100 enterocytes (or 8/20 | | | | intestine biopsy. Others, particularly those without |
| enterocytes). More recently that standard has | | | | DQ2 or DQ8 appear not to be at significant risk |
| been lowered to 30 per 100 (6/20) though | | | | for true celiac disease but respond favorably to a |
| recently the literature has suggested that the | | | | gluten free diet. |
| number should be as low as 25 per 100 (5/20). | | | | Celiac disease biopsy: Who needs a biopsy? |
| Other studies have reported potential celiac | | | | If you have suggestive symptoms, a family |
| disease should be suggested by an average of | | | | history or risk factors for celiac disease then you |
| greater than 9-12 lymphocytes per villous tip over | | | | should undergo complete blood test screening |
| 5 villi. Sometimes, the lymphocytes are hard to | | | | AND a small bowel biopsy before initiating a gluten |
| see or count so special stains are needed or | | | | free diet. This will determine if you have specific |
| indicated. These stains stain the particular type of | | | | blood tests and a characteristic diagnostic biopsy. |
| lymphocyte that is activated in celiac disease | | | | Genetic testing for DQ2 and DQ8 can determine |
| allowing them to be seen and counted quite easily. | | | | if you carry either of the major gene patterns |
| This also may be helpful when someone has | | | | present in over 98% of people with celiac disease |
| already restricted gluten in their diet or initiated a | | | | but their presence does not confirm celiac |
| gluten free diet prior to the biopsy. | | | | (30-40% of people carry one or both of the |
| Celiac disease biopsy: What does gluten sensitivity | | | | genes in the U.S.) nor does their absence exclude |
| look like on biopsy? | | | | gluten sensitivity or a remote chance of celiac |
| The symptoms of gluten sensitivity can be | | | | disease. |
| present and improve with gluten free diet in | | | | |