The diagnosis of celiac disease is confirmed by the characteristic abnormal appearance of the small intestine under a microscope. The smoothing of a normal finger, like protrusions, called villi, accompanied by signs of inflammation, is taken as an indication of the damage or damage to the cellular protein gluten in wheat and similar proteins in barley and rye. Biopsy of the small intestine has become the gold standard for establishing the diagnosis of celiac disease or gluten-sensitive enteropathy. Until 1960, the removal of gluten with subsequent improvement and subsequent deterioration after re-examination was a diagnostic criterion.
In the early 1960s in the 1970s, the small intestine was a biopsy when people swallowed a small metal capsule attached to a suction tube. This was used to suck the tissue into a capsule before guillotining some of the tissues, once it was confirmed that the capsule was in the small intestine using X-rays. The tissue is now obtained using upper endoscopy, passing the lighted volume of the video through the mouth under sedation into the small intestine, where biopsies are obtained with the help of a cupped forceps.
Celiac Disease Biopsy: What does the pathologist look for under a microscope?
In the small intestine there are usually finger-shaped protrusions, called villi, which give it a large surface area or contact area for absorption. The villi lead to a wool mat or terry cloth. The lining of the outer surface of each villi is intestinal cells or enterocytes, which are secretive mucus and absorb liquids, nutrients, minerals such as iron, and vitamins like B12. Digestive enzymes, such as lactase, which digest lactose or milk sugar, are found on the surface of the enterocytes. At the base of the villi are crypts or circular similar collections of intestinal cells.
Celiac biopsy: What is fleecy atrophy?
Typically, the villi are 3-5 times longer than the crypts are high. However, damage to the intestine can lead to blunting, reduction (partial atrophy of the villi) or complete loss of the villi and flattening (villous atrophy) of the intestinal surface. A rug-rug will have bare spots, or a terry cloth towel will look like a T-shirt. The result is a lack of absorption of nutrients and water, which leads to weight loss, malnutrition and diarrhea.
Celiac biopsy: what if the biopsy does not exhibit atrophy or partial atrophy?
If the villi are at least 3 times larger than the crypts, then there is no flattening or blunting of the villi, and celiac disease becomes more difficult to diagnose the pathologist without a history or blood test. However, an increase in the number of IEL (intraepithelial lymphocytes) when establishing a positive specific blood test for celiac disease, symptoms, and especially if it is confirmed by the presence of the DQ2 gene and / or DQ8, suggests celiac disease. The difficulty arises when blood tests for specific tests are negative or not elevated, but only “non-specific” blood tests (antigliadin or AGA and antibodies against reticulin) increase. In addition, some people with milder forms of celiac disease do not have any blood tests, but they have classical biopsy data of celiac disease and are called seronegative (negative blood tests) celiac disease.
Celiac Disease Biopsy: Can a Biopsy Be Normal in Celiac Disease?
By definition, biopsy is considered the gold standard for diagnosing celiac disease. However, recent studies have shown that biopsy may be normal in some people with celiac disease. How can it be? The pathologist reading a biopsy can interpret the biopsy as usual depending on his or her bias regarding celiac disease, the inability to assess the significance of having an IEL or the incorrect use of an older standard> 40 IEL. at 100. However, more importantly, the recent admission that normal biopsies may not be normal. Electron microscopy revealed ultrastructural abnormalities when a normal biopsy of people confirmed for celiac disease appeared. Special patches that include lymphocyte immunization labeling have also confirmed an increase in the number of specific types of specific lymphocytes in the villi of an intestinal biopsy of people confirmed for celiac disease. The bottom line is that a normal biopsy does not completely eliminate celiac disease or gluten sensitivity.
Celiac disease - diase biopsy: What are other possible causes of biopsy changes that mimic celiac disease?
(CMSE), viral or bacterial infections, drugs (especially aspirin medicines, such as ibuprofen, etc.), Autoimmune enteropathy, Helicobacter pylori infection (gastric ulcers), AID, common variable immunodeficiency and intestinal lymphoma are all possible causes changes in the small intestine that can mimic celiac disease. However, if you have the classic symptoms of celiac disease, a positive celiac disease antibody (an anti-endomysial antibody or a tissue transglutaminase antibody) and a positive response to a gluten-free diet, then celiac disease is the most likely cause. The likelihood increases if you carry one or both of the two main genes associated with celiac disease, DQ2 and / or DQ8. Normalization of celiac disease with specific blood tests and a biopsy after a gluten-free diet confirms the diagnosis of celiac disease.
