What You Need To Know About Intestinal Biopsies

Failure to obtain a biopsy during endoscopy results in loss of important treatable bowel conditions

Thousands of people undergo endoscopy every day without taking tissue samples. Sadly, their examinations may appear visually normal, but often under a microscope there are microscopic findings that explain symptoms that respond to the indicated treatment. The intestines are lined with surface cells that contain several immune cells that attract other cells to the area and release chemical mediators that fight alien invaders.

Some cells that can only be seen under a microscope are involved in gastrointestinal symptoms

Lymphocytes, eosinophils, and mast cells are immune cells that are usually present in small numbers in the surface cells of the gastrointestinal tract. A small number of lymphocytes exist at the tip of the surface cell, which is a type of epithelial cell. These lymphocytes act as body scouts. They investigate intestinal barriers into the body and look for signs of infectious pathogens. When an attack is recognized, they signal reinforcements to join the attack at the forefront.

Lymphocytes are immune cells detected early in celiac disease, causing intestinal symptoms

A chronic inflammatory state of the intestine exists when a continuous increase in lymphocytes is present in the surface cells. In the duodenum, an autoimmune response to gluten in a genetically susceptible individual is common, but it is easy to overlook the cause of chronic inflammation, more commonly known as celiac disease or sprue.

Eosinophils and mast cells are allergic cells, often causing food-induced intestinal inflammation

Eosinophils and mast cells are a type of immune cell involved in allergic reactions in the body. They are rarely found in the gastrointestinal lining, except when there are parasites, food allergies, or chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis. Eosinophilic gastrointestinal disorders are less common, and if there is an excess of mast cells in the small intestine and colon, a newly recognized state of mast cell enteritis is diagnosed. However, it may be difficult to see mast cells on a biopsy unless you specifically stain tryptase, an enzyme present in immunologically activated mast cells.

Allergic esophageal conditions may mimic reflux but are due to food and eosinophils

The esophagus usually does not contain eosinophils. Two exceptions to gastroesophageal acid reflux usually occur in the lower esophagus, not just in the middle or upper part of the esophagus, but a small number of up to 6 to 7 and up to 10 to 12 [40 times] per high magnification field. Is allergic eosinophilic esophagitis more than 15 eosinophils per high-power field, or more than 20-24 per high-power field in one field? Diagnosed when there are fewer numbers in the upper esophagus. Activated mast cells have also been found to be associated with allergic eosinophilic esophagitis, whose presence supports allergic esophagitis due to reflux as a cause of eosinophilia, The state is considered to coexist.

Allergic cells and immune cells in the stomach and intestine that cause symptoms under a microscope

In the stomach and small intestine, more than 10 eosinophils per high-power field define eosinophilic gastroenteritis. In the small intestine and colon, more than 20 mast cells per high-power field that are associated with unexplained diarrhea are called mast cell enteritis. This newly recognized and described entity was not previously recognized in some patients diagnosed with irritable bowel syndrome who were not biopsied but were told to have a normal colon test It is the cause of diarrhea. Similarly, more than 20 lymphocytes per 100 epithelial cells of the colon are found in lymphocytic colitis. This is another form of microscopic inflammation of the intestine that results in diarrhea that is inappropriately diagnosed with IBS.

Gluten grains in wheat, barley and rye cause an increase in lymphocytes in a normal blood test

Many of these patients are attributed to gluten hypersensitivity, and lymphocytic colitis appears to represent the colon type of celiac disease. In celiac disease, more than 30 lymphocytes at the tip of the villus per 100 epithelial cells are the earliest signs of gluten damage before the villus becomes flat or dull. This finding may occur before certain blood tests, anti-endometrial [EMA] and anti-tissue transglutaminase [tTG] antibodies appear in the blood, even if the intestine is damaged enough to cause malnutrition and diarrhea. May be pointed out. However, anti-gliadin antibodies are often present when significant intraepithelial lymphocytosis is present, along with symptoms that respond to a gluten-free diet. Lesser degrees of intraepithelial lymphocytosis have been proposed in the range of 20-25 per 100 epithelial cells as strongly suggesting early celiac disease and / or gluten sensitivity.

The colon can be affected early with only microscopic signs

In the colon, the presence of eosinophils is considered one of the earliest findings of chronic inflammatory bowel disease. In the right colon, more than 20 eosinophils per high-power field and in the left colon more than 20 eosinophils per high-power field are considered abnormal, eosinophilic colitis, chronic inflammatory bowel disease Or suggest a parasitic infection.

Allergic cells release chemicals, causing pain, diarrhea and sometimes constipation

Eosinophils and mast cells release chemicals that stimulate the intestine, increasing permeability [causing intestinal leakage], increasing intestinal contraction, increasing intestinal secretion, and increasing pain. Both cells are associated with allergies, including food allergies. Therefore, it is not difficult to think of a link to adverse food reactions in the development of intestinal inflammation.

Most gastrointestinal symptoms should be evaluated with scope and blood tests

An important point to note if you have gastrointestinal symptoms and are undergoing endoscopy is that the normal intestinal lining is damaged or irritate enough to cause symptoms of pain, flatulence, gas, diarrhea It does not exclude the presence of digestive and absorption disorders. Although blood tests exist to help screen for celiac disease, Crohn's disease, and ulcerative colitis, a definite diagnosis usually requires a biopsy of the intestinal lining.

Intestinal lining that looks normal may not be normal, so be sure to have a biopsy

Only by obtaining a tissue sample to be examined under a microscope can an abnormal type and number of inflammatory cells be identified. The correct diagnosis of various microscopic forms of gastrointestinal inflammatory disease is confirmed through a biopsy of the normally visible intestinal lining. Therefore, if you are preparing to have an endoscopy, it is recommended that a doctor insist that a biopsy be performed even if the test appears to be normal. Based on the information I reviewed above, the usual test that one of these microscopic conditions may be due to your symptoms should be chipped off.

Reference:

Al-Haddad S and Ridell RH. “The role of eosinophils in inflammatory bowel disease.” Got 2005; 54: 1674-1675.

Girarte M et al. “Diarrhea-type IBS patients show mast cell activation and hyperplasia in the jejunum.” Gut 2007; 56: 203-209.

Jakarte S et al. “Mast cell enteritis.” Increased mucosal mast cells in chronic intractable diarrhea. “Arch Pathol Lab Med. 2006; 130: 362-367.

Kirsch R etc. “Activated mucosal mast cells differentiate between eosinophilic [allergic] esophagitis and gastroesophageal reflux disease.” Journal of Pediatric Gastroenterology and Nutrition 2007; 44: 20-26.

Rear crow CA. “Eosinophilic gastrointestinal disorders.” Practical gastroenterology, March 2007. 53-67.

Rubio CA etc. “Lymphocytic esophagitis: a histological subset of chronic esophagitis.” Am J Clin Pathol. 2006; 125 [3]: 432-437.

Yusef MM et al. “Duodenal intraepithelial lymphocytes in esophageal and gastric disorders”. Clinical Gastroenterology and Liverology 2006; 4: 631--634.