Suspected Coeliac Disease: Explaining Endoscopy
Your Role — Doctor
Gastroenterology Clinic
Your 34-year-old patient has months of bloating, diarrhoea and fatigue, and blood tests show strongly positive coeliac antibodies (anti-tTG). A confirmatory endoscopy with duodenal biopsy is needed while the patient continues eating gluten. The patient is anxious about the procedure and confused about why they must keep eating something that makes them unwell. You need to explain the diagnosis, the need for and nature of the endoscopy, and next steps.
- •Explain the likely diagnosis of coeliac disease in plain terms and how the blood tests point to it.
- •Explain why an endoscopy with biopsy is needed to confirm the diagnosis before committing to a lifelong gluten-free diet.
- •Explain clearly why the patient must keep eating gluten until the test — stopping now could give a falsely normal result.
- •Describe what the endoscopy involves practically (sedation option, throat spray, duration, taking small samples, low risk) to reduce anxiety.
- •Outline next steps after diagnosis (dietitian, gluten-free diet, monitoring) and arrange the test with written information.
The Interlocutor
Played by the actor / assessor
You are 34 and have felt unwell for months — bloated, tired, and with frequent diarrhoea. You looked up your symptoms and are relieved there might be an answer, but you're frightened of having a camera put down your throat. You don't understand why, if gluten is the problem, you're being told to keep eating it.
- •Say you're relieved there might finally be an explanation, but the idea of an endoscopy makes you very nervous.
- •Ask whether the camera will hurt and whether you'll be awake for it.
- •Say you don't understand why you have to keep eating bread and pasta when they seem to make you feel worse.
- •Ask whether you could just try a gluten-free diet now and skip the test.
- •If the doctor explains clearly and reassures you about sedation, agree to have the endoscopy while continuing to eat gluten until then.
Sample Role-play
Hello Ms Byrne, I'm Dr Shah. Thank you for coming in. I've got your blood results and I'd like to explain what they show and what I'm suggesting next. Is that alright?
Yes please. I've been feeling awful for months, so honestly I'm just relieved someone might have an answer.
That relief is completely understandable — months of feeling unwell is exhausting. Your blood test strongly suggests a condition called coeliac disease. It means your immune system reacts to gluten, a protein in wheat, barley and rye, and that reaction damages the lining of your gut, which explains the bloating, diarrhoea and tiredness.
So it is the bread and pasta making me ill. Right — so I just stop eating them?
You're exactly right that gluten is the culprit, and a gluten-free diet will be the treatment for life. But before we commit you to that, I'd like to confirm it properly with a test called an endoscopy, where we take tiny samples from your gut lining. Confirming it first matters because it's a lifelong change and we want to be certain.
A camera down my throat — that's the bit that scares me. Will it hurt? Will I be awake?
That's a very common worry, so let me talk you through it. It's a thin, flexible camera. You can choose numbing throat spray while staying awake, or light sedation to make you drowsy and relaxed — many people barely remember it. It takes about ten minutes, the samples are painless, and it's a very safe, routine test. You won't feel the biopsies at all.
That's not as bad as I imagined. But here's what I don't get — if gluten is hurting me, why must I keep eating it until then?
That's a really sensible question. The test looks for the damage gluten causes. If you stop eating it now, the gut can start to heal, and the test might look normal even though you have coeliac disease — so we'd miss it. Keeping gluten in your diet until the endoscopy makes sure the result is accurate. I know that means feeling unwell a little longer, and I'm sorry about that.
I see — I don't want to go through all this and get the wrong answer. Okay, I'll keep eating it until the test.
Thank you — that's exactly the right approach. Once it's confirmed, I'll refer you to a specialist dietitian who'll make the gluten-free diet much easier than it sounds, and we'll check things like your iron and vitamin levels. I'll arrange the endoscopy and give you a leaflet explaining everything, including how to prepare.
Thank you, that's really helped. I feel much calmer about it now.
I'm glad. Do call us if any questions come up before the appointment, and we'll get you booked in soon. You've handled this really well.
Useful Phrases
Clinical Background
Coeliac disease is confirmed by duodenal biopsy (villous atrophy) while the patient remains on a gluten-containing diet; serology (anti-tTG IgA, with total IgA) supports but does not replace biopsy in adults. Premature gluten withdrawal risks false-negative histology. Post-diagnosis: lifelong gluten-free diet, dietitian referral, screening for nutritional deficiencies (iron, folate, B12, vitamin D), bone health, and associated autoimmune conditions. Clear explanation of the pre-test gluten challenge improves adherence.
Common Mistakes to Avoid
- ✕Not explaining why the patient must continue eating gluten, leading them to start a gluten-free diet and invalidate the test.
- ✕Underplaying or glossing over procedural anxiety instead of describing sedation and the process concretely.
- ✕Using terms like 'villous atrophy' or 'serology' without translating them for the patient.