| When undergoing an evaluation for possible celiac | | | | reached especially when a longer endoscope is |
| disease or gluten sensitive enteropathy doctors | | | | used. The resolution of video images are very |
| usually recommend an upper endoscopy and small | | | | high with the latest endoscopes and also may |
| intestine biopsy. What that may mean or why it is | | | | have a magnification and color contrast mode to |
| recommended may not be clear to people who | | | | detect very subtle signs of damage of the small |
| are facing the decision to undergo the procedure | | | | intestine. |
| themselves or to subject their child to the exam. | | | | Endoscopy in celiac: What are the typical findings? |
| Endoscopy in celiac: What is it and how is it done? | | | | The characteristic appearance of the surface of |
| The medical name for upper endoscopy is | | | | the small intestine in celiac disease include |
| esophagogastroduodenoscopy or EGD for short. | | | | superficial ulcerations that are commonly linear, |
| The endoscope is a thin flexible tube about the | | | | flattening of the folds, notching or scalloping of the |
| diameter of a fat pencil that has a video chip in | | | | folds and a mosaic like pattern. However, the |
| the end and channels for flushing of water, | | | | surface may appear normal and only under |
| suctioning of secretions and passage of | | | | microscopic examination of samples will the lining |
| instruments. It has dials that allow the tube to be | | | | show signs of gluten caused injury. |
| turned up/down and right and left at the tip | | | | Endoscopy in celiac: What are biopsies? |
| permitting it to be passed through the mouth, | | | | Samples of small intestine are obtained with |
| down the esophagus or feeding tube, into the | | | | biopsy forceps that consist of tiny jaws with cups |
| stomach and then into the first part of the small | | | | that permit pinching off samples of the intestinal |
| intestine the duodenum, hence the name EGD. | | | | lining. This is painless and very safe. The samples |
| Endoscopy in celiac: Do you feel it or remember | | | | are sent to a pathology lab in a preservative |
| it? | | | | solution, processed, mounted on a microscope |
| People undergoing the exam in the U.S. typically | | | | slide, and stained for examination under the |
| are sedated with a medication. Medications similar | | | | microscope by a pathologist. Small intestine injury |
| to valium with good amnesia and relaxing effect | | | | from gluten may be patchy, therefore, several |
| called midazolam or versed combined with a | | | | samples are recommended. A minimum of 4 |
| narcotic like meperidine (demerol) or fentanyl are | | | | pieces and preferably 8-12 samples should be |
| generally used. More recently a very short acting | | | | obtained to avoid missing microscopic signs of |
| intravenous sedative, propofol (diprovan), may be | | | | celiac disease. |
| administered for deep sedation or an intravenous | | | | Endoscopy in celiac: What does the pathologist |
| form of general anesthesia. Occasionally, usually in | | | | look for on the slides? |
| very young children or people with severe lung | | | | The pathologist examines the slide for evidence |
| problems, general anesthesia is required. The | | | | of damage or injury characteristic of gluten |
| exam is usually not felt or remembered because | | | | sensitivity. Occasionally special stains are required |
| of the medications. | | | | to see signs of irritation known as inflammation |
| Endoscopy in celiac: What is examined in celiac and | | | | characterized by an increased number of a type |
| how well can the lining be seen? | | | | of immune active white blood cells called |
| Celiac disease affects the upper portion of the | | | | lymphocytes. In early celiac and gluten sensitivity |
| small intestine, in the two sections known as the | | | | without celiac disease the biopsy may be normal |
| duodenum and jejunum. The examination of the | | | | and the diagnosis cannot be established by the |
| small intestine is usually limited to the first section | | | | biopsy. |
| termed the duodenum though occasionally the | | | | Endoscopy in celiac: Summary. |
| second section known as the jejunum may be | | | | |