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Is Biopsy Really Necessary?
September 22, 2010
The intestinal biopsy is typically the last step in definitively diagnosing celiac disease. Positive blood test results usually prompt the biopsy. A team of researchers from Argentina says, however, that for many patients, a combination of certain blood tests are so accurate they may eliminate the need for the biopsy.
In the study, the team examined how well the celiac blood tests perform, individually and in combination, in over 600 adults. They found that using a combination of two blood tests--the widely used anti-tissue transglutaminase (tTG) and the new deamidated gliadin peptide (DGP) test--it was possible to reach or rule out a celiac diagnosis without the biopsy in 92 percent of study subjects. (Click here for more about DGP testing and important issues surrounding celiac testing.)
What does this news mean to you and me?
Had I been part of that research, I think I would have been among the 92 percent. I knew I had celiac disease before undergoing my biopsy. I had the classic symptoms and my blood tests were “off the charts.” So it came as no surprise when the doctor called me a few days later with the biopsy results: celiac disease. For me, the biopsy felt like a formality. And with the medical costs and risks involved with the biopsy procedure, was it really necessary?
Celiac experts say yes, the biopsy is still necessary. A key reason is to be absolutely certain of the diagnosis. Celiac disease requires a strict, lifelong adherence to the gluten-free diet. Such a rigorous lifestyle change shouldn’t be entered into lightly, they maintain.
As a celiac, I appreciate how serious a celiac diagnosis is--few things have had such a big impact on my life--but it would be exciting if additional research led to blood tests one day taking the place of the biopsy, at least in some cases.
Note: The American College of Gastroenterology advises anyone concerned that they may have celiac disease not restrict their diet (follow a gluten-free diet) before seeking medical evaluation, because this may cause false negative test results.