Diagnostic Challenges of Celiac Disease

False-Positive Biopsies

June 2010

There are many reasons why biopsies may look like celiac disease, but are not; the condition of graft-versus-host disease, recent chemotherapy, Sjögren syndrome. Crohn disease is a rare cause of such pathologic change and often is quite obvious to the endoscopist, or by other means of patient investigation. Bacterial overgrowth, while is thought to be relatively common, is unlikely to cause injury of the degree seen in celiac disease. In young children, other food protein intolerances can cause histologic changes in the small intestine, but this is rare in adults.

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False-Positive Biopsies

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Jump to section:

• Introduction
• Case 1: Negative Serology for Celiac Disease
• Limitations of Serology
• Case 2: Symptomatic Malabsorption
• Biopsy First?
• Comparison of Serological Tests
• Comparison of Serological Tests
• Marsh Classification
• Autoimmune Enteropathy²
• Autoimmune Enteropathy²
• False-Positive Biopsies
• False-Positive Biopsies
• Minimal Disease: Uncertain Histology
• Lymphocytic Duodenosis⁴
• Patient Presenting on Gluten-free Diet
• What About Patients on Gluten-free Diet?
• Gluten Challenge Testing
• Celiac Disease and HLA Risk
• Genetic Tests-Big Limitation⁵
• References
• Questions?