Majid Ali, M.D.

As a hospital pathologist, I examined many intestinal tissue biopsies and prepared pathology reports. I described the microscopic features which I observed in the biopsy slides (inflammation, and clubbing and loss of villi projecting from the surface of the lining of the gut). Then I wrote in the report thgat these changes were compatible but not diagnostic of gluten sensitivity and celiac disease.

I  never signed a pathology report with a definitive diagnosis of celiac disease.  Nor do most senior pathologists do so. Why?

Why did I never render a definitive diagnosis of celiac disease when reporting on an intestinal biopsy? Because there are no established microscopic features which are exclusive for celiac disease.  So, pathologists cannot make the diagnosis of celiac disease and gluten sensitivity with a microscopic study of an intestinal biopsy material.

I examined and reported a large number of intestinal biopsies done to diagnose celiac disease. I never signed a pathology report with a definitive diagnosis of celiac disease. Nor did any of my three associate pathologists. The reason: there are no definitive microscopic abnormalities seen exclusively in celiac disease and gluten sensitivity which have not been seen in other intestinal inflammatory conditions. Thus, an absolute microscopic diagnosis of celiac disease is not possible. I know that senior pathologist with decades of experience of microscopic study of inflammatory and autoimmune disorders of the bowel do not disagree with this.

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