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Is a biopsy always necessary to diagnose celiac disease?

Performing an intestinal biopsy is still considered the “gold standard” for diagnosing celiac disease, meaning that one usually does not get an official diagnosis of celiac disease unless they have a tube put down their throats and bits of their intestines removed and analyzed. Actually, I didn’t think the endoscopy was that bad. It was painless — I was drugged of course, and in my foggy state I got to see inside my own intestines on the monitor! How cool is that?

But watching your child get prodded and poked is another story. I never had to make that decision since my kids have been gluten-free since the womb. I talk to many mothers whose children have had blood test after blood test as doctors try to figure out what is wrong. I feel for the mothers and fathers who don’t want another invasive procedure performed on their child, not to mention those who may not have adequate medical insurance to cover it. There are some who opt to not have the biopsy, who say “the blood test is good enough for me” and adopt a gluten-free diet. Unfortunately because they don’t get a diagnosis of “celiac disease”, they are considered just gluten intolerant and left out of any statistics that might help raise awareness.

Well, perhaps a positive blood test is good enough. According to a new study out of the UK, the immunoglobulin-A tissue transglutaminase (tTG) antibody test is 100% positive for predicting celiac disease at a certain level. In their research, all people who had a very high tTG blood antibody level (10 times the upper limit of normal) tested positive on the biopsy. What does this mean? That a biopsy is not always necessary!

The conclusion of the researchers was this: “…diagnostic guidelines could be modified so that small bowel biopsy is no longer regarded as mandatory in patients with such high transglutaminase antibody levels. This will avoid an invasive procedure and lead to a more rapid diagnosis and earlier treatment for over half of the new patients with coeliac disease.”

I hope that doctors are up on the latest research — it could save people from unnecessary medical procedures and parents from having to make such a difficult decision.

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