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If you have Coeliac Disease, then the epithelial (skin) cells that line your villi get poisoned by the toxic effects of gluten. These poisoned cells die much more quickly. Because they die off quickly, the villi cannot grow very long – therefore, they do not absorb the food as well. Also, now the crypts now have to work overtime to produce even more cells to line your villi. Thus the crypts keep on enlarging. Should everyone have a small bowel biopsy? Currently, the diagnosis of CD is based on biopsy evidence. The blood tests are getting better, but if you want to find tissue damage, then you have to have a biopsy by endoscopy. In my opinion, not everyone needs to have a small bowel biopsy. However, it is a very important investigation to make the CD diagnosis. An endoscopy should not be rejected lightly. Currently, the criteria that I use to decide are as follows. I advise a biopsy the following groups: - All children and adults who have elevated tTG or EMA antibodies, where there is no family history.
- In children who have substantially elevated IgA-gliadin antibody levels.
- In children with no family history with symptoms and substantially elevated IgG-gliadin antibody levels
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