Why biopsy before diagnosis?

Biopsy is a gold standard for diagnosis of celiac disease. A positive serology does not necessarily mean celiac disease as is exemplified by some case studies here.

Case 1

A 12 year old girl presented with abdominal pain to her pediatrician who suspected her to have celiac disease. Celiac serology was carried out which showed highly elevated tTG antibodies. Based on this, celiac disease was diagnosed and she was asked to start and maintain a gluten free diet.

Despite consuming gluten free diet for 2 months, there was no improvement in her health. Celiac serology was repeated which did not show any change - i.e., her tTG was still elevated. A gastroenterologist was referred to who advised her to restart gluten for 2 months and come back for an endoscopy.

The endoscopy finding showed that she had an extensive gastritis secondary to Helicobacter pylori (a bacterial infection of the stomach) and her duodenal biopsy was not suggestive of celiac disease.  She was treated for the bacterial infection after which her abdominal pain vanished, even though she continued to consume gluten.

After 3 months of completion of the treatment, her tTG antibody report was negative.

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Gluten Free & Beyond