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Duodenal ( G I) Biopsy

Biopsy
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Report in 240Hrs

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No Fasting Required

Details

Tissue biopsy of duodenum.

₹666₹951

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Duodenal (GI) Biopsy - Comprehensive Medical Test Information Guide

  • Why is it done?
    • Test Purpose: A duodenal biopsy involves obtaining small tissue samples from the duodenum (the first part of the small intestine) for microscopic examination to diagnose gastrointestinal disorders and detect abnormalities in the intestinal lining.
    • Primary Indications:
    • Suspected celiac disease diagnosis and confirmation
    • Investigation of chronic diarrhea and malabsorption disorders
    • Detection of Helicobacter pylori (H. pylori) infection
    • Diagnosis of tropical sprue and Whipple's disease
    • Evaluation of unexplained iron deficiency anemia
    • Assessment of villous atrophy and mucosal damage
    • Investigation of dermatitis herpetiformis
    • Diagnosis of lambliasis and other parasitic infections
    • Typical Timing/Circumstances: Performed during upper endoscopy (esophagogastroduodenoscopy) when clinical symptoms warrant histological evaluation; typically done when serological testing suggests celiac disease, or when gastrointestinal symptoms persist despite normal standard testing.
  • Normal Range
    • Normal Histological Findings:
    • Intact intestinal villi with normal height and structure
    • Villus-to-crypt ratio of approximately 3:1 to 5:1
    • Normal epithelial lining without erosions or ulcerations
    • Absence of pathogenic organisms or parasites
    • Normal inflammatory cell infiltration (baseline lymphocytes)
    • H. pylori stain negative or minimal presence
    • Result Interpretation:
    • Negative/Normal: No evidence of pathology, infection, or malabsorption disease; normal mucosal architecture preserved
    • Positive/Abnormal: Histological changes indicating disease such as villous atrophy, increased intraepithelial lymphocytes, inflammatory infiltration, or presence of organisms
    • Marsh Classification: Used specifically for celiac disease grading from 0 (normal) to 3c (total villous atrophy)
  • Interpretation
    • Celiac Disease Findings: Partial (Marsh 1-2) or total villous atrophy (Marsh 3); increased intraepithelial lymphocytes; inflammatory infiltration in lamina propria; crypt hyperplasia
    • H. pylori Infection: Curved gram-negative bacilli visible on special stains (Giemsa, immunohistochemical); chronic inflammation and gastritis; may appear in antrum and corpus
    • Tropical Sprue: Partial villous atrophy; prominent inflammatory infiltration; architectural distortion less severe than celiac disease
    • Whipple's Disease: Foamy macrophages in lamina propria filled with PAS-positive, diastase-resistant granules; pathognomonic appearance of Tropheryma whipplei
    • Giardiasis: Trophozoites and cysts visible on villous surfaces and crypts; partial villous atrophy; variable inflammation
    • Factors Affecting Interpretation:
    • Biopsy location (multiple sites recommended for accuracy)
    • Timing of biopsy relative to treatment initiation
    • Patient compliance with specific diets prior to testing
    • Specimen handling and fixation quality
    • Pathologist expertise in gastrointestinal histology
  • Associated Organs
    • Primary Organ System: Gastrointestinal tract, specifically the duodenum (first portion of small intestine); also involves the entire small intestinal tract in disease processes
    • Commonly Associated Conditions with Abnormal Results:
    • Celiac disease (gluten-sensitive enteropathy) - most common indication
    • Dermatitis herpetiformis - skin manifestation of celiac disease
    • Helicobacter pylori gastroduodenitis and peptic ulcer disease
    • Tropical sprue - endemic malabsorption syndrome
    • Whipple's disease - rare systemic infectious disease
    • Giardiasis and other parasitic infections
    • Common variable immunodeficiency with intestinal involvement
    • Crohn's disease affecting the duodenum
    • Infectious enteritis from various bacterial or viral agents
    • Diseases Helped by This Test:
    • Definitive diagnosis of celiac disease through histological confirmation
    • Detection of H. pylori for treatment planning
    • Identification of parasitic infections with targeted therapy
    • Potential Complications/Risks with Abnormal Results:
    • Malabsorption leading to nutrient deficiencies and anemia
    • Increased risk of osteoporosis and bone fractures
    • Development of secondary conditions if untreated (lymphoma, autoimmune disorders)
    • Untreated H. pylori infection may lead to ulcers or gastric cancer
    • Systemic spread of infectious agents if parasitic disease not treated
  • Follow-up Tests
    • Recommended Follow-up Based on Results:
    • If Celiac Disease Confirmed: Serological monitoring (tissue transglutaminase IgA antibodies) every 6-12 months; repeat biopsy after 2-3 years on gluten-free diet to confirm mucosal healing
    • If H. pylori Positive: Initiation of triple or quadruple antibiotic therapy; confirmation testing (urea breath test or stool antigen) 4 weeks post-treatment
    • If Parasitic Infection Detected: Stool studies repeated post-treatment; specialized microscopy or molecular studies for parasite confirmation and species identification
    • Nutritional panel assessment: Iron studies, vitamin B12 and folate levels, prothrombin time (PT), calcium, vitamin D levels
    • If Inflammatory Changes Present: Repeat endoscopy with biopsy in 4-8 weeks after initiating specific therapy to assess response
    • Further Investigations May Include:
    • Serology testing for celiac disease (tissue transglutaminase, endomysial antibodies, deamidated gliadin peptides)
    • Immunoglobulin A (IgA) level to rule out IgA deficiency
    • Bone density imaging (DEXA scan) in celiac disease for osteoporosis assessment
    • Upper endoscopy repeat if biopsy inconclusive or patchy disease suspected
    • Genetic testing (HLA-DQ2/DQ8) if celiac disease diagnosis uncertain
    • Monitoring Frequency:
    • Celiac disease: Clinical assessment every 6-12 months; serology monitoring annually; repeat biopsy in 2-3 years
    • H. pylori: Eradication testing 4 weeks post-treatment; surveillance upper endoscopy if atrophic gastritis or intestinal metaplasia present
    • Malabsorption conditions: Monthly to quarterly monitoring based on symptom resolution and nutritional status
  • Fasting Required?
    • Fasting Requirement: YES - Fasting is required
    • Fasting Duration: NPO (nothing by mouth) for 6-8 hours prior to the procedure; typically scheduled for early morning to minimize fasting duration
    • Medications to Avoid:
    • Proton pump inhibitors (omeprazole, lansoprazole) - discontinue 2 weeks prior if H. pylori testing planned; reduces organism visibility
    • H2-receptor antagonists (ranitidine, famotidine) - discontinue 24 hours prior
    • Antibiotics - discontinue 4 weeks prior to H. pylori testing if possible
    • Aspirin and NSAIDs may be continued unless specifically instructed otherwise; discontinue if bleeding risk is a concern
    • Patient Preparation Instructions:
    • Clear liquid diet for 24 hours prior to procedure; or NPO after midnight if morning appointment
    • Small sips of water allowed up to 2 hours before procedure
    • If celiac disease biopsy: Continue normal gluten diet (at least 4 weeks) prior to testing; do not start gluten-free diet before diagnosis confirmation
    • Remove all dentures, glasses, and jewelry on day of procedure
    • Arrange for responsible adult to drive home post-procedure due to sedation use
    • Inform physician of allergies, bleeding disorders, and current anticoagulation therapy
    • Wear comfortable, loose-fitting clothing for easy access to veins for IV placement

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