Celiac Disease Testing and Biopsies – Video

Celiac Disease Testing?

Intestinal biopsies used to be considered the ‘gold standard’ for diagnosis. No more. Discover why in this video by Dr. Vikki Petersen.

Summary of the video:

Dr. Petersen discusses a case where a woman, suffering from digestive symptoms, is about to undergo an intestinal biopsy. The doctor plans to take three samples during the procedure. Dr. Petersen explains that while a positive biopsy confirms celiac disease, a negative result doesn’t necessarily rule out gluten as a problem. She recommends additional blood tests such as the transglutaminase test and endomyfield test, which are commonly positive when significant damage has occurred. However, she notes these tests are limited because they only detect advanced damage.

To diagnose issues earlier, Dr. Petersen suggests using more sensitive tests, like the Immunoglobulin A and G tests for gliadin. She also recommends an elimination and provocation test, where gluten is removed from the diet for at least a month to see if symptoms improve, which can be an effective diagnostic tool. She mentions EnteroLab, where people can order tests online to perform at home, even if they’ve already eliminated gluten from their diet.


Hello, Dr. Vikki Petersen here. A reader writes in about his wife who has been suffering a lot of digestive complaints, and they’re wondering if she has celiac disease. She’s made an appointment to have an intestinal biopsy, and his question was, is that adequate? The doctor plans to take three segments or three sections when he performs the biopsy, and this husband wanted to know, was that adequate and anything else that they should do to really get to the underlying cause of his wife’s digestive symptoms. That’s a very excellent question and one I could probably spend an hour answering, but I will abbreviate it as best I can.

So here the situation is this: If a doctor performs an intestinal biopsy and it’s positive, that means that the intestinal lining, or known as the villi, the finger-like projections that make up the surface area of the small intestine, have been completely mowed down or eradicated, and that’s a positive celiac disease testing. And so, if one receives a biopsy and the test is positive, well then you know for sure you’re celiac. However, what if that test is negative? Does that mean that gluten is not at all a problem for you? It does not. It does not mean that at all.

So, there are several questions I would ask. Number one, has this woman had any celiac disease testing, the transglutaminase test, the endomysial test? Now these blood tests have problems or liabilities as well, in that they are positive a very high percentage of the time when someone has celiac and once again have little villi all but mowed down.

So, do understand that when you’re at that stage of degradation of your small intestine, which is a very important organ in your body, you have been mal-absorbing for such a long time, there’s so many secondary health issues including autoimmune disease and cancer that can lie in the future of someone who’s in that sort of state. That certainly, while making the diagnosis is great because now the person can start to heal and make some changes, what we’re really after is making that diagnosis earlier.

So even if this woman had had those blood tests, the standard celiac blood test plus had the biopsy, if all of those were negative, she’d still not be out of the woods as far as gluten perhaps causing a problem in her health.

So, I do recommend the immunoglobulin A and the immunoglobulin G blood test for gliadin because those tests are much more sensitive. They’re going to show a reaction of the body’s immune system to gluten or gliadin long before that small intestine has been completely degraded.

And the concept of the biopsy, going back to that for just a moment, as being the gold standard of celiac diagnosis, that is becoming antiquated as far as recent research in the past five years. What the scientists are saying is that it is so gross of a test, meaning so much damage has to occur before that test is positive, that it’s really not what we need. We need a more sensitive test and at the moment we have two: we have the immunoglobulin test that I just mentioned, and we also have a very simple inexpensive test called elimination and provocation, meaning you eliminate gluten from your diet for a month, three weeks minimum but I would recommend a month, and then see how you feel. And that is considered a positive test and is considered the most positive test as far as sensitively letting your body tell you if you’re having a reaction to the substance.

So please don’t let anyone negate that as far as being a very positive, sensitive, and important test of changing your diet. But you must be vigilant, and you must be accurate about changing your diet. You can’t half-heartedly get gluten out of your diet. It must be a hundred percent, as best as you possibly can, in order to really see if this test is positive for you, meaning you feel better being off gluten.

EnteroLab is a lab that you can go online and get celiac disease testing, and you don’t have to be consuming gluten at the time which is nice, so if you’ve been off at a few weeks already, you can still do the EnteroLab. You can go online and get that test sent to you and do the test yourself.

There’s been a lot of wonderful change in the area of gluten sensitivity and celiac disease. We’ve been a bit stuck with the biopsy and the blood test as being the only true diagnosis, and what we’re realizing, and I’ve realized this as a clinician as has the doctors that work with me, but what science has realized is that these tests are not what we need. They’re too little too late. Certainly, having it done and being positive, of course, now you know, but what about those people that are told because the test is negative they’re fine, and for many that’s a falsehood, which is why we diagnose so few celiacs percentage-wise, and so many people are suffering from gluten sensitivity unnecessarily.

So, I hope that helps, and until next time, I wish you very good health.

Additional resources:

The Functional Medicine Approach

Celiac disease testing at the Mayo Clinic

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