What is the gold standard diagnostic procedure to evaluate intestinal involvement in suspected celiac disease?

• A. Small bowel biopsy via Esophagogastroduodenoscopy
• B. Colonoscopy
• C. Abdominal ultrasound
• D. Capsule endoscopy

Answer: (A)

For suspected celiac disease, confirming intestinal involvement relies on tissue to prove the diagnosis. The best way to do this is a small-bowel biopsy obtained during an esophagogastroduodenoscopy. Multiple biopsies from the duodenum or proximal jejunum reveal the classic histologic pattern of celiac disease—villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes—which provides definitive confirmation and guides management. Serology helps screen, but imaging alone isn’t diagnostic, and colonoscopy or abdominal ultrasound don’t assess the small-bowel mucosa or allow biopsies. Capsule endoscopy can visualize mucosa but cannot obtain the necessary tissue for confirmation, so it isn’t the gold standard.