The Biopsy has long been considered the gold standard for a celiac disease diagnosis.
Do you remember that the very definition of celiac disease is 'villous atrophy'?
Well, a biopsy is used to test for villous atrophy.
What this means is that all the other celiac disease tests tests are measured against the biopsy.
Does this also mean that one would have to undergo a biopsy test in order for a diagnosis to be confirmed? Not necessarily, many gluten intolerance doctors us the blood tests to diagnose celiac.
The biopsy is a complicated and invasive procedure, but still its necessity may be warranted.
In a nutshell, a flexible tube is inserted into the upper part of the small intestine via the throat and stomach.
The doctor can then view the inside of the patient's stomach and intestinal tract for abnormalities.
In addition, the doc also takes a duodenal biopsy, that is, microscopic tissues that can then be examined for villous atrophy.
The biopsy test procedure is generally an outpatient procedure but does involve some anesthesia.
According to some celiac experts such as Dr Stephen Wangen,there are various things that could go wrong with a biopsy test.
For example, it can be very subjective depending on the experience of the doctors.
As well, it can so happen that villous atrophy is not detected even when it is present. Or if it is, it may not be all that severe or or obvious.
Another thing to note is that, a lot of people decide to get tested for celiac disease long after they've given up gluten. At that point the villi may have started to recover, or even fully recovered.
This actually happened to my friend's husband, Josh. He self-diagnosed after researching celiac disease symptoms, stopped eating glutinous products and then several months later decided to get tested.
The biopsy came back negative. He went back to eating gluten, and the symptoms returned with a vengeance.
Of course, he ended up deciding to ditch gluten anyway!
Another possible problem with the biopsy is that villous atrophy can be caused by other things, such as HIV, Crohn's disease or a myriad of others.
So why is it then still considered the gold standard?
Habit maybe? Who knows!
Some celiac experts argue that a simple blood test, the endomysial antibody test (IgA EMA) is pretty effective in diagnosing celiac disease.
Read here for more details about blood tests for celiac disease, and here for other forms of celiac disease testing.