What to Expect From an Endoscopy for Celiac Disease

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The diagnosis of celiac disease usually involves blood tests and an endoscopy. During an endoscopy for celiac disease, your healthcare provider will look directly at your small intestine and take small samples to examine further under a microscope.

This article explains what to expect before, during, and after an endoscopy for celiac disease.

Internist during stomach examination with tools for a gastroscopy

Yakobchuk Olena / Getty Images

What Exactly Is an Endoscopy?

The term "endoscopy" refers to the insertion of a medical instrument called an endoscope through a natural or surgical opening in the body. This instrument allows providers to see that everything is in order, or possibly to identify a problem. Sometimes they even can fix a problem at the same time.

The endoscope is a thin, flexible tube with a fiber-optic light source and a tiny video camera on the tip. Endoscopes have at least one channel through which tiny tools can be passed. These tools can be used to snip off a tiny sample for examination under a microscope, to control bleeding, to remove polyps, to stretch narrowed areas, and for many other therapies.

Upper gastrointestinal (GI) endoscopies are performed by gastroenterologists. During the procedure, your healthcare provider can examine the esophagus, the stomach, and the beginning of the small intestine (called the duodenum).

As your healthcare provider advances the endoscope through the body, an enlarged view from the instrument's video camera is displayed on a TV or computer monitor. In addition to using the tools at the end of the scope to take small pieces of tissue for biopsy samples, the healthcare provider can also capture still photos of questionable areas.

Endoscopies can be performed in a healthcare provider's office, an ambulatory surgical center, or a hospital. Where yours is done will depend in part on whether you have other medical conditions that may need special attention.

Before Your Upper GI Endoscopy

Your healthcare provider will give you written instructions in advance on how to prepare, which may include the following:

  • Stop eating and drinking at least eight hours before the procedure. Food in the stomach will block the view through the endoscope and could even cause vomiting.
  • Remember that you have to keep eating gluten for an accurate celiac disease diagnosis, so don't go gluten-free until your healthcare provider gives you the okay. A common recommendation is to eat half a slice of bread each day for two weeks before the endoscopy. This may be uncomfortable, but it's necessary.
  • Stop taking aspirin, ibuprofen, Pepto Bismol, or other blood-thinning medications for several days in advance.
  • Stop everything by mouth two hours before the endoscopy. This includes smoking and chewing gum or mints.
  • Wear loose, comfortable clothing. You may be able to wear short-sleeved clothing under your gown.
  • Have someone drive you home after the procedure, as you will be given sedatives right before the endoscopy.
  • Plan on taking the day of your procedure off from work. If you’re a parent with small kids at home, try to arrange to have someone stay with you that day to help take care of them so you can rest.

For an upper GI endoscopy, you will not need to drink a polyethylene glycol electrolyte solution the night before as a laxative, as you would if you were having a colonoscopy (which is an endoscopic examination of your colon).

During Your Endoscopy Procedure

Before the procedure begins, your healthcare provider will give you a sedative to help you feel relaxed and drowsy. They may also spray your throat with a local anesthetic so you don't feel the endoscope go down.

During the procedure:

  • You’ll be lying down, with enough blankets to keep you warm. In many cases, people even fall asleep. You may end up sleeping through the whole procedure. Even if you’re not completely asleep, you should feel little to no pain—in fact, most people don't even remember what happens during their endoscopy.
  • Your blood pressure, pulse, and oxygen level will be closely monitored.
  • You'll be given a mouthpiece to help keep your mouth open.
  • The gastroenterologist will gently maneuver the endoscope through your mouth, your esophagus, your stomach, and into the first part of your small intestine.
  • As the endoscope is slowly inserted, air is also introduced, which helps the healthcare provider see better.
  • To find out whether you have celiac disease, your healthcare provider will take some small tissue samples (biopsies) from your small intestinal lining, which the pathologist will later examine under a microscope. This part of the procedure is painless.

Usually, an upper GI endoscopy takes 10 to 20 minutes.

After the Endoscopy

When your endoscopy is finished:

  • You will rest in a recovery area until most of the sedative has worn off.
  • You will be able to have something to drink, and you'll be fairly alert, but not alert enough to drive yourself home.
  • Before you leave, the healthcare provider will tell you how the procedure went, but you won’t get any biopsy results for several days.
  • You’ll be given written guidelines that tell you how soon you can start eating regularly again, and when you can resume your usual activities.
  • Some people feel no symptoms afterward. Others may have a mild sore throat or feel bloated for a short while.

Any remaining effects from the sedative, anesthetic, and endoscopy should wear off by the next day.

Endoscopy Results

Most people get their endoscopy results a few days after the procedure. A healthcare provider will likely call you, or schedule an appointment to discuss the results.

Changes in the intestine caused by celiac can often be seen on the monitor during an endoscopy, but not always.

When it can be seen, the finger-like villi structures on the walls of the intestine, which are responsible for absorbing nutrients, will appear shorter and less pronounced compared to healthy villi. This is known as villous atrophy. Characteristic changes in the grooves and folds of the intestine may also be visible.

In at least 23% of celiac disease diagnoses, there are no signs of celiac disease visible during the endoscopy. In these cases, the diagnosis is made via the biopsy.

Possible Complications

Although unlikely, possible complications associated with upper GI endoscopy include:

  • Infection
  • Bleeding
  • A tear in the lining (perforation) of the duodenum, esophagus, or stomach
  • Reactions to administered medications
  • Complications related to sedation, such as decreased breathing rate or heart rate
  • Aspiration, in which stomach contents are inhaled into the lungs

Summary

Before your upper GI endoscopy, your healthcare provider will give you detailed instructions on how to prepare. If you are being tested for celiac disease, you will need to eat gluten each day for two weeks before the endoscopy. Before the endoscopy, you will be sedated and given an anesthetic. You may fall asleep during the procedure. You will need someone else to drive you home and shouldn't make plans for the rest of the day. In many cases, you will know the result of the endoscopy within a few days.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Stanford Medicine. Preparing for an upper endoscopy (EGD).

  2. University of Michigan Medicine. Upper endoscopy (EGD) prep instructions.

  3. National Celiac Association. Diagnosing celiac disease after going on a gluten-free diet.

  4. Gastroenterology Group of Rochester. Upper endoscopy of Rochester.

  5. National Institute of Diabetes and Digestive and Kidney Diseases. Upper GI endoscopy.

  6. St Marks National Bowel Hospital. Upper gastrointestinal endoscopy.

  7. Scheppach M, Rauber D, Stallhofer J, et al. Detection of duodenal villous atrophy on endoscopic images using deep learning algorithm. GIE. 2023 May;911-916. doi:10.1016/j.gie.2023.01.006

  8. Johns Hopkins Medicine. Upper GI endoscopy.

  9. Waddingham W, Kamram U, Kumar B, Trudgill N, Tsiamoulos Z, Banks M. Complications of diagnostic upper gastrointestinal endoscopy: common and rare - recognition, assessment and management. BMJ Open Gastroenterol. 2022;9(1):e000688. doi:10.1136/bmjgast-2021-000688

Additional Reading
  • American Gastroenterological Association fact sheet.

  • National Institute of Diabetes and Digestive and Kidney Diseases. Upper GI Endoscopy fact sheet.

By Nancy Lapid
Nancy Ehrlich Lapid is an expert on celiac disease and serves as the Editor-in-Charge at Reuters Health.