Do you need an endoscopy to diagnose celiac disease?

Dr Rodney Ford on YouTube

Dr Rodney Ford on YouTube

This is the text of a video on my YouTube channel.

 Do you need an endoscopy to diagnose celiac disease?

I have yet again been asked this question in my clinic and today. This is my opinion.

It is a complicated issue because celiac disease many years ago (50 years or more) it was diagnosed exclusively on the basis of the damage seen (by microscope appearance) of the small bowel.  Yes, in the olden days, you had to have an endoscopy to make the diagnosis of celiac disease.  Also, 50 years ago there were no blood tests available.  All blood tests at that time were indirect (looking for malabsorption); the only definite way to tell if the bowel was damaged was by having a look see – taking a piece of tissue (this is the endoscopy).  And this is the sort of thing that was looked for: you can see the top section shows normal villous; the middle one shows villous atrophy; and the bottom one shows a flat villous (the extreme villous atrophy of celiac disease).  Yes, this was the basis of the endoscopy.

But, over the last few years (the last decade), there have been fantastic advances made in blood tests.  Initially, there was a test called the EMA (endomysial antibody) and then the tTG (tissue transglutaminase) and now another one called DGP (deamidated gliadin peptide).  These tests are extremely sensitive and very good of picking up the evidence of any gluten gut damage.  So much so, that they can be positive a long time before any gut damage can be seen through the microscope.  So nowadays, to make a diagnosis of coeliac disease you really only need to have high tissue antibodies showing gut damage.

But it is still traditional to do the endoscopy, but it is not necessary: if you have the gene for celiac disease; if you have raised tissue antibodies to tissue damage; and if you recover gluten-free – that’s all you need (to make your diagnosis).  So the endoscopy is becoming an unnecessary  tool.  It is still used by tradition, but the new ESPGHAN definition of celiac disease makes the endoscopy “not mandatory”, but a useful adjunct.

I have written a lot about this and I have written “The Gluten Syndrome” which takes you through this issue, and if you want to know a lot more about what tests you should get, what they mean, and what you should do to make a diagnosis of coeliac disease and gluten sensitivity – then have a look at this book

I would like to remind you that for every one coeliac that is diagnosed, there are another ten people who have got Gluten Syndrome (also called: non-coeliac gluten sensitivity; or gluten intolerance; or gluten sensitivity.  Gluten affects at least 1-in-10 people, whilst 1-in-100 people are affected by coeliac disease (that requires a test for tissue damage antibodies, or/and the endoscopy).

The last thing to say is that people with Gluten Syndrome, most have a normal biopsy.  So if you have a normal small biopsy does not rule out a gluten problem. Do you need an endoscopy to diagnose celiac disease? – not always!

Thanks I hope this helps.  Subscribe to this YouTube channel

by Rodney Ford.