Endoscopy and intestinal biopsy - nutrition

Endoscopy and intestinal biopsy are essential procedures for diagnosing celiac disease. In this section, we will detail what these two techniques consist of, how they are performed, the indications for their use and how the results are interpreted.

If the serology test is positive and the patient is an adult, it is necessary to perform these procedures to confirm the diagnosis.

If the serology is negative, but there is suspicion of celiac disease due to symptoms or family history, it is also advisable to perform an endoscopy and intestinal biopsy.

Preparation for the procedures

Endoscopy and intestinal biopsy are safe and well-tolerated procedures with few complications. However, because they are invasive, they can cause mild discomfort, such as sore throat and abdominal discomfort.

General preparation guidelines include:

• Fasting: Fasting beforehand is required to ensure that the stomach and bowel are empty during endoscopy, as directed by the physician.
• Discontinuation of medications: Some medications may interfere with the procedures, so it is important to inform the physician of any medications being taken.
• Report allergies and medical conditions: Inform your physician of any allergies or relevant medical conditions.
• Follow dietary restrictions: Some dietary restrictions may be necessary, such as avoiding certain foods that may interfere with visualization during endoscopy.

It is important that these procedures are performed while the person is still consuming gluten, in order to obtain accurate results and avoid false negatives.

Description of the procedures

Endoscopy is performed with an endoscope, a thin tube with a camera and light at the end, which allows visualization of the inside of the gastrointestinal tract.

During endoscopy, the patient is placed in a lateral position, local anesthesia is administered in the throat, and the endoscope is introduced through the mouth until it reaches the duodenum, the first part of the small intestine.

If suspicious areas are detected, biopsies are taken from different parts of the small intestine for laboratory analysis. These samples are analyzed for the presence of lesions typical of celiac disease, such as lymphocyte infiltration and atrophy of the intestinal villi.

Endoscopy with biopsy usually takes 15 to 30 minutes, and biopsy results are usually available 3 to 7 working days after the procedure.

Result of the intestinal biopsy

Interpretation of the biopsy is based on the Marsh classification, which evaluates damage to the intestinal lining on a scale of 0 to 3, with 3c being the most severe grade.

The Marsh scale ranges from less severe to more severe:

• Grade 0: There are no significant histologic changes in the intestinal villi.
• Grade 1: There is inflammatory cell infiltrate in the lamina propria of the intestine, but the villi are intact.
• Grade 2: Partial atrophy of the intestinal villi is observed.
• Grade 3a: Subtotal atrophy of the intestinal villi.
• Grade 3b: Subtotal atrophy plus hyperplasia of the intestinal crypts.
• Grade 3c: Total villous atrophy and inflammatory infiltration.

If the diagnosis is positive, even with mild damage, treatment consists of a strict gluten-free diet.

If you are interested in nutrition courses on offer click here.