Two new studies look into how children are diagnosed with celiac disease: both studies look at biopsies in very different ways. Both studies are published in the May 2011 issue of the Journal of Pediatric Gastroenterology and Nutrition.
Study #1: Kids May Not Need a Biopsy
We all know the endoscopy and biopsy process is the “gold standard” test for confirming celiac disease. But new research says a small intestinal biopsy may not always be necessary in children. Researchers found of the 128 people with a tTGA level >100, 124 had villous atrophy (a flattening of the villi) confirming celiac disease. Three of the others had crypt hyperplasia, which can be another symptom in the small intestine pointing to celiac disease. The fourth had a false positive. In this patient “no histological abnormalities were found. This patient did not respond to a gluten free diet”.
Researchers concluded, “Pediatric patients with a tTGA level >100 U/mL in whom symptoms improve upon consuming a gluten free diet may not need a small intestinal biopsy to confirm celiac disease.”
Does this mean skip it? Probably not if your GI recommends getting it right away. But for some, if your child has improved significantly on the gluten free diet, it may sound like torture to put them back on gluten just for the biopsy. It is possible this is where the research says if your child had the blood test and was positive and is doing better on the diet, the biopsy may not be necessary. That’s my layman’s opinion. You should always consult your GI about this issue.
Study #2: Which Biopsy Process is More Accurate for Celiac?
Doctors in this study looked small bowel biopsies for 184 children — 130 were done by endoscopy and 54 by suction capsule (the only definition of this capsule was on Wikipedia which may be an unreliable source. But click here to see what they say about this capsule method).
Of that number 16 had normal or inconclusive biopsies (12 were from the suction capsule) and they were re-biopsied with an endoscopy, which resulted in an additional 8 confirmed celiac cases.
Researchers concluded, “To improve the quality of childhood celiac disease diagnostics, we recommend multiple endoscopic biopsies from both proximal and distal duodenum and standardized evaluation by a pathologist with good knowledge of celiac disease”. It also acknowledged “several cases would have been missed by relying only on local routines” (which I presume means the aforementioned suction capsule).
So if your child is going for a biopsy, and you hear that it could be something other than an endoscopy, you may want to push for the endoscopy since research is showing it is more reliable. Again — this is my layman’s take.
*I am not a medical doctor. Always consult your physician or gastroenterologist with any medical questions you may have.