Endoscopy costs are too much to be sustained as the diagnostic test for celiac. Endoscopy costs huge amounts.
Endoscopy costs huge
Endoscopy is an expensive medical procedure done to diagnose [or more usually to confirm] the presence of the intestinal damage of celiac disease – and celiac disease is in turn defined by endoscopy (the diagnostic procedure). This is inter-dependence on each other is what’s known as a tautology. In other words, you cannot officially have celiac disease without endoscopic proof. This drives the business of endoscopy, especially as celiac disease is now recognised as a very common condition.
However, the majority of gluten related illnesses cannot be assessed/confirmed/diagnosed by endoscopy. A negative endoscopy result does not rule out a gluten problem. In fact. most gluten-related diseases have a normal endoscopy result.
Nowadays, the blood tests that pick up intestinal damage are more accurate than endoscopy. These tissue-damage blood tests are: tTG (tissue TransGlutaminase), DGP (Deamidated Gliadin Peptide) and EMA (EndoMesial Antibody). But these tests do not tell you about other gluten-related illnesses.
Finally, endoscopy is very expensive. It costs several thousands of dollars. In the USA that are over 300 million people, of whom 1% have celiac disease. To diagnose them all by endoscopy would cost a lot of money (maybe 30,000,000 x $4,000 = a huge amount of dollars). Why go to such extreme measures? Why spend so much money?
Endoscopy is very useful in many patients, but should not be mandatory for the diagnosis of Celiac disease. In fact, this is now being recognised in the newer guidelines for making a diagnosis of celiac disease ( the “Joint BSPGHAN and Coeliac UK Guidelines for the Diagnosis and Management of Celiac Disease in Children” http://www.medscape.com/viewarticle/811355_2?nlid=36263_455). With a statement that if the tTG is very high, then a biopsy may not be needed, as well as the high tTG the EMA+ and patient either DQ2 or DQ8, the diagnosis is confirmed without the need for a duodenal biopsy.
By Rodney Ford