The Celiac Endoscopy: What to Expect During the Biopsy

You went to the doctor, took the celiac blood test (tTG-IgA), and it came back positive.

Your doctor just told you that to make it official, you need to see a gastroenterologist for an upper endoscopy.

For many people, the idea of having a camera put down their throat is terrifying. But in reality, the celiac endoscopy is a fast, painless, and incredibly routine procedure. Here is exactly what to expect before, during, and after your biopsy.

Why Do You Need an Endoscopy?

The blood test tells the doctor that your immune system is producing antibodies against gluten. However, false positives do exist, and the blood test cannot show the *extent* of the physical damage.

The endoscopy is the gold standard for celiac diagnosis. The doctor needs to physically look at your small intestine and take microscopic tissue samples (biopsies) to see if the villi are blunted or destroyed.

CRITICAL RULE: Do NOT stop eating gluten before your endoscopy. If you go on a gluten-free diet before the biopsy, your intestines will heal, and the test will be a false negative. You must keep eating gluten until the day of the procedure.

The Preparation (The Day Before)

Unlike a colonoscopy (which requires drinking massive amounts of brutal laxatives), the prep for an upper endoscopy is incredibly easy.

* Fasting: You simply stop eating and drinking. Usually, you cannot have any solid food for 8 hours before the procedure, and no liquids (including water) for 2 to 4 hours before.

* Medications: Your doctor will tell you which morning medications to skip.

The Procedure: Step-by-Step

The entire appointment takes about two hours, but the procedure itself takes less than 15 minutes.

The Recovery (The Days After)

Because you had anesthesia, you are legally not allowed to drive yourself home. You must have a friend or family member pick you up.

* Throat Pain: You might have a mild sore throat for 24 hours. Drink cool water or suck on lozenges.

* Gas/Bloating: The doctor uses air to inflate your stomach during the procedure to see clearly. You might feel a bit bloated and burp more than usual for the rest of the day.

* Eating: You can usually eat a normal meal immediately after leaving the clinic. This is often your last "hurrah" meal before officially going gluten-free!

The Results

The doctor will usually speak to you before you leave. They can tell you if your intestines *looked* visually inflamed, but you will not get an official diagnosis that day.

The tissue samples must be sent to a lab to be examined under a microscope. It usually takes 1 to 2 weeks for the biopsy results to come back. Once they confirm the villi damage (the Marsh Score), you are officially diagnosed and must begin a strict 100% gluten-free diet for the rest of your life.