Why Do You Need an Endoscopy to Diagnose Celiac Disease?The first step in the diagnosis of celiac disease is usually a set of blood tests to measure levels of certain autoantibodies. Next, because one of the hallmarks of celiac disease is damage to the lining of the small intestine, pathologists need to study biopsy samples of tissue taken from the small intestine during a procedure called an upper gastrointestinal (GI) endoscopy.
The term "endoscopy" refers to any technique that lets doctors insert an endoscope through an opening in the body (a natural opening, or a surgical incision) to allow them to look around and either assure that everything is in order, or identify –- and sometimes fix -– a problem. The endoscope itself is a thin, flexible tube with a fiberoptic light source and a tiny video camera on the tip. In addition to cameras, endoscopes have at least one channel through which tiny tools can be passed. These tools can be used to biopsy an area, control bleeding, remove polyps, stretch narrowed areas and many other therapies.
Upper GI endoscopies are done by gastroenterologists. During the procedure, they can examine the esophagus, the stomach, and the beginning of the small intestine (the duodenum). As the doctor advances the endoscope through the body, an enlarged view from the video camera on the tip is displayed on a TV or computer monitor, giving a clear, detailed display. In addition to using the tools on the end of the scope to take small pieces of tissue for biopsy samples, the doctor can also capture specific screen shots (still photos) of questionable areas.
Endoscopies can be performed in a doctor’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 the Upper GI EndoscopyYour doctor will give you written instructions in advance on how to prepare. You’ll need to stop eating and drinking about eight to 10 before the procedure because food in the stomach will block the view through the endoscope and could also cause vomiting. You may be told to stop taking aspirin, ibuprofen, or other blood-thinning medications for several days in advance.
For an upper GI endoscopy, you will not need to drink an electrolyte solution the night before, as you would if you were having an endoscopic examination of your colon (a colonoscopy).
You’ll be given sedatives right before the endoscopy, so you’ll need to have someone else drive you home afterward. You should plan on taking the entire day 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.
During the EndoscopyBefore the procedure begins, your doctor will give you a sedative to help you feel relaxed and drowsy. You may also have your throat sprayed with a local anesthetic.
During the procedure itself, you’ll be lying down, with enough blankets to keep you warm. In many cases, patients 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. Your blood pressure, pulse and oxygen level will be closely monitored.
Usually, an upper GI endoscopy takes 15 to 20 minutes. You'll be given a mouthpiece to help keep your mouth open. Then 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 doctor see better. To find out whether you have celiac disease, your doctor will take some small tissue samples (the biopsy) from your small intestine, which the pathologist will later examine under a microscope. The biopsy is painless.
After the EndoscopyWhen your endoscopy is finished, you will rest in a recovery area until most of the sedative has worn off. You’ll 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 doctor 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 afterwards. Others may have a mild sore throat or feel bloated for a short while.
Possible ComplicationsHere’s what the American Gastroenterological Association says about the risks associated with having an upper GI endoscopy.
Years of experience have proved that upper GI endoscopy is a safe procedure and complications rarely occur. These include perforation, puncture of the intestinal wall that could require surgical repair, and bleeding, which could require transfusion. Again, these complications are unlikely; be sure to discuss any specific concerns you may have with your doctor.