Poor Biopsy Practices Could Contribute to Underdiagnosis of Celiac Disease

July 7, 2011

Poor Biopsy Practices Could Contribute to Underdiagnosis of Celiac Disease


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Study finds that 65% of biopsies have an insufficient number of samples; better sampling could boost diagnosis sevenfold.

Small intestinal biopsy is currently the gold standard of celiac disease diagnosis, but a new study found that 65% of patients who underwent biopsy had an insufficient number of samples taken. Professional guidelines recommend that at least four samples be taken for an accurate diagnosis, but researchers found that, in most cases, physicians only took two.

The study analyzed records from a nationwide pathology database, and compared the diagnostic rate among cases that included at least four biopsy samples. According to researchers, the diagnosis rate doubled when physicians took the recommended number of samples.

In cases of suspected celiac disease, as defined by having a positive celiac blood test, etc., adherence to biopsy guidelines was still low, with only 40% of patients having four or more samples taken. Most striking, the diagnosis rate increased sevenfold when the proper amount of samples were collected, according to the study.

“In this study, we identified just one of the factors contributing to the high rate of under-diagnosis of celiac disease in the United States. We plan on studying other physician-related factors that may also be operative,” said Dr. Peter Green, Director of the Celiac Center Columbia University Medical Center and one of the study’s authors.

Lead author Benjamin Lebwohl, MD, MS, a gastroenterologist at the Celiac Disease Center at Columbia University Medical Center, presented the findings at the 2011 International Coeliac Disease Symposium (ICDS), held in Norway last month.

For more information, read the press release.