Lab results - looking for opinions [PLEASE READ 1ST POST]

David Flores68 said:I think I was remembering things wrong regarding the whole mix-up with celiac disease and the samples. The doctor performing the endoscopy definitely took a duodenal biopsy (here is his report)...



...however, the only report I actually received from the pathologist is the one in the previous post, which is titled esophagus biopsy (even though it mentions the tissue corresponds to the stomach mucosa, but I assume the mucosa is similar in the esophagus) and there's no mention of the duodenum or celiac disease. Is it possible the pathologist processed the duodenal samples too, but I was mistakenly given only the report for the cardia tissue? I remember the technician searching for the results for quite a while; perhaps there were two papers (esophagus and duodenum), and she accidentally handed me just the esophagus one?

Now I see that I confused myself as well, and it’s actually a stomach biopsy rather than an esophagus one, despite what the title says.

Basically, the sample is stomach mucosa, so the changes aren't related to reflux—my apologies.

My answer regarding celiac disease still stands—the stomach or esophagus mucosa isn't where you'd see specific changes tied to celiac disease, so the pathologist wouldn't have commented on it. Since the gastroenterologist's report mentions a duodenal biopsy, you would expect the pathology report to describe the duodenal mucosa as well. If it's missing, it's possible that during the endoscopy, they didn't take a duodenal sample but instead focused on the stomach, since the pathology report refers to "stomach mucosa samples" in the plural. There is also the possibility that the findings were described separately, though it isn't standard practice to issue separate reports for samples taken during the same endoscopy.

Regarding the other part of your question: typically, to diagnose *H. pylori*, biopsies are taken from several different parts of the stomach, specifically the antrum and the corpus, because the bacteria can be unevenly distributed throughout the lining. Furthermore, your report describes intestinal metaplasia, and *H. pylori* is rarely found in areas with intestinal metaplasia. It prefers an acidic environment, whereas gastric acid secretion decreases in areas with intestinal metaplasia, making it less hospitable. So, it isn't unusual that only rare bacteria were noted in the report.

Intestinal metaplasia is a precancerous condition and increases the risk of developing stomach cancer. Regular follow-ups are necessary.

Diagnosing *H. pylori* via a stool antigen test is highly accurate. It is possible, though very rare, for that test to come back negative even if *H. pylori* is present in a biopsy. However, that is quite uncommon.

To clear up the dilemma of whether the bacteria in a biopsy is *H. pylori* or not, immunohistochemical analysis can sometimes help, but it is generally recommended to take a larger number of biopsy samples and look for *H. pylori* in samples where intestinal metaplasia is absent.

You should consult your gastroenterologist with these results to discuss monitoring and next steps.

steeleagle152 said:I’ve had blood work done before, but never this detailed. No one really sent me for it. My CRP has been consistently elevated since my splenectomy (following a car accident). It goes from 15 to higher, but usually hovers somewhere between 15 and 20. I don't smoke or drink. I am overweight, though I stay active through my job—it isn't a desk job. I only take medication for high blood pressure, and occasionally Praxiten (about three or four times a month) because I work three shifts; when I can't sleep after a night shift, I take one tablet. As for why the results look small... I don't know. Maybe it's just because I uploaded them via my phone to the forum.
Thanks for the clarifications.

Ma'am,

Elevated CRP levels shouldn't be linked to a splenectomy—that might happen in patients with thalassemia, but that doesn't apply here—rather, they indicate inflammation. Essentially, there is an inflammatory process occurring in the body. Granted, obesity can also trigger inflammation, which could reflect as an increased CRP level. Still, quite a bit of this is unusual. I suggest more comprehensive testing; the combination of elevated leukocytes, neutrophils, and CRP suggests an inflammatory cause that remains unclear based on what you've shared.

Maria Fisher46 said:Ma'am,

I guess elevated CRP levels shouldn't really be linked to a splenectomy—unless we're talking about someone with thalassemia, which isn't you—so it's more likely just inflammation. It basically means there's an inflammatory process going on in your body. I suppose being overweight can also cause inflammation, which might show up as high CRP too. Still, a lot of this seems a bit odd in your case. Maybe you should get a more thorough workup, since having high leukocytes, neutrophils, and CRP all at once suggests some kind of inflammation where the cause isn't totally clear from what you've told me.

Thanks for the reply.

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So, last Friday I went in for a urine test because I thought I might have an infection. Glucose came back negative, but my ketones were at 1+...
I’ve been reading up on it, and apparently, that can be a red flag for diabetes, but it also happens when you're fasting.
Given that I haven't eaten a single thing for about 23 hours—just drinking water—because my stomach was killing me, is it more likely these ketones are just from starving, or should I be worried about diabetes?
Is 23 hours enough time without food for ketones to actually show up?
I'm 125 lbs, BMI 23.5... I mean, I've definitely put on some muscle over the last few years, but my waist is around 36-37 inches.

Once I finish this round of antibiotics, I'm thinking about getting the urine tested again, but there's still a long way to go since this prescription is a full two-week course.

cosmicmoose2 said:Last Friday, I had a urine test done because I suspected an infection. Glucose came back negative, but ketones were at 1+.
I’ve read that this can be a sign of diabetes, but it also shows up during fasting.
Given that I haven't eaten anything for about 23 hours due to stomach pains (just water), is it more likely that these ketones are from fasting, or should I get checked for diabetes?
Is 23 hours without food long enough for ketones to show up?
I'm 137 lbs, BMI 23.5... I've put on a bit of muscle over the last few years, but my waist is around 36 inches.

Once I finish this course of antibiotics, I plan to repeat the urine test, but there's still a while to go since this prescription is for two weeks.

Hello,

We're looking at ketonuria caused by fasting. Even shorter periods of fasting can trigger ketonuria, so 23 hours certainly qualifies.

Maria Fisher46 said:It looks like I've managed to confuse myself as well—it turns out we’re actually looking at a stomach biopsy, not an esophageal one like the title of the report suggests.

Actually, I need to correct myself—the sample was taken from the gastric mucosa, which means these changes aren't actually related to reflux. My apologies.

My previous response regarding celiac disease still stands—the stomach or esophagus lining isn't actually where you'd see those specific changes associated with celiac, which is why the pathologist didn't weigh in on that particular issue. Since the gastroenterologist’s report specifically mentions a duodenal biopsy, one would naturally expect the histopathology report to describe the duodenal mucosa as well. If that description is missing, there is a real possibility that during the endoscopy, they didn't actually take a duodenal sample at all, but rather focused on the stomach—especially since the pathologist’s report refers to "stomach mucosa samples," implying plurality. There is also the slight chance that the findings were documented in a separate report, though it’s certainly not standard practice to split up samples taken during a single endoscopy into different results.

Regarding the second part of your question—standard practice for diagnosing *Helicobacter* usually involves taking biopsies from several different areas of the stomach, specifically the antrum and the corpus, because these bacteria don't always distribute themselves evenly across the gastric mucosa. Furthermore, your results indicate intestinal metaplasia, and frankly, *Helicobacter* is rarely found in areas where intestinal metaplasia is present. To put it simply, the bacteria thrive in an acidic environment; however, in areas affected by intestinal metaplasia, gastric acid secretion decreases—which just isn't a hospitable environment for them. Therefore, it isn't at all surprising that the findings only show rare traces of the bacteria.

Intestinal metaplasia is essentially a precancerous condition—it bumps up the risk for developing stomach cancer. Because of that, you really can't afford to skip regular follow-up screenings.

Stool antigen testing for *H. pylori* diagnosis is highly accurate. It is possible—though extremely rare—to see a negative result on that test only to have *H. pylori* show up later in a biopsy. Still, that kind of discrepancy is quite uncommon.

When you're trying to settle the debate over whether a biopsy actually shows *H. pylori* or if it’s just a false lead, sometimes an extra step—like immunohistochemical analysis—can clear things up. That said, my advice is always to be thorough: grab a larger number of biopsy samples if you can, and specifically look for *H. pylori* in those areas where you aren't seeing any intestinal metaplasia.

With these results in hand, you really ought to schedule an appointment with your gastroenterologist—it’s best to sit down with them to coordinate your follow-up care and map out the next steps in your treatment plan.

Thanks for sharing your thoughts!

I have some additional lab results—I didn't want to dump them all here immediately because the post would have been massive, but I figured I'd share them now just in case they change the overall picture. There’s quite a lot to go through, so I’ll try to summarize the main points in bullet points and skip over the minor details:

After that gastroscopy—this was back on February 13, 2014—here is what came back.



February 20, 2014 — Negative stool test for Helicobacter.

February 28, 2014 — underwent a new gastroscopy.


So, here’s the deal—the HP didn't show up on this one. But, just like you pointed out earlier, they really ought to be taking biopsies from several different sections of the stomach, whereas here, they only grabbed a sample from one spot. On top of that, if I'm reading this correctly, the initial gastroscopy actually picked up HP at the cardia—yet, in this specific instance, they didn't even take a biopsy from the cardia.

November 18, 2014 — Ferritin and IgA levels both came back normal.

- Dec 18, 2014 - H. pylori came back negative again.

- March 11, 2016 - fT3, TSH, and fT4 were all normal.

- April 28, 2022.
Vitamin D was low (likely because I stay out of the sun far too much), and IgA and beta globulins were questionable.

ESR, CRP, protein levels, and calprotectin were all within normal range.

- I've had quite a few blood tests over the years, so I'll list them here.

- Symptoms:

There have been plenty of them over the years—constant gas every minute after eating, bloating and popping sounds in the gut (almost like tiny bubbles forming and bursting), stomach burning, a sensation of being overly distended if I eat too much followed by discomfort/pain, sensitivity to acidic foods (like apples, for instance), getting full way too quickly, and various other issues.

The symptoms have actually eased up over the years—they're very rare now—but the weight loss persists. My target weight is 65 kg (which I’ve maintained comfortably in the past, never dropping lower), yet since the onset of these symptoms, I haven't been above 60 kg. To me, this suggests that whatever the underlying issue was, it's still hanging around somewhere.

Regarding monitoring the metaplasia: since it's located—I assume—right where that ulceration used to be at the cardia, is it necessary to take another biopsy from the cardia to see if the metaplasia has progressed? Or is that something a doctor can just spot visually during a gastroscopy without needing a biopsy?

To whom it may concern,

The samples collected during your second endoscopy weren't quite "sufficient." The material was too sparse, making it impossible to draw any definitive conclusions from the analysis. It’s unclear why an IgA test was ordered back in November 2014, given that you have an isolated IgA deficiency; those results simply aren't relevant here. I wouldn't go so far as to say celiac disease is ruled out—the small intestine biopsy was inadequate for a proper assessment, and both the IgA and tTg IgA tests are moot in your situation. Furthermore, the stomach biopsy was thin. It is entirely possible that areas of intestinal metaplasia still exist but were missed by the biopsy. Remember, intestinal metaplasia doesn't always show up macroscopically. As I believe I've mentioned before, your normal calprotectin levels, combined with a normal CRP and ESR, suggest there is a low probability that your gastrointestinal issues are linked to inflammatory bowel disease.

To be blunt, based on the findings provided, it’s difficult to reach any coherent conclusion.

Maria Fisher46 said:Hey there,

We’re talking about ketonuria caused by fasting here. Even a short fast can show up as ketonuria, but 23 hours of fasting? That definitely does it...

Got it. Thanks so much for the answer!

Maria Fisher46 said:Dear patient,

The samples collected during the second endoscopy weren't quite "high quality"—to put it bluntly, there simply wasn't enough material to draw any definitive conclusions based on the analysis provided. It’s also unclear why an IgA test was ordered back in November 2014, given that you have an isolated IgA deficiency, which makes those specific results irrelevant. I wouldn't go so far as to say celiac disease is ruled out—since the small intestine biopsy was inadequate for a proper analysis, and both the IgA and tTg IgA tests are essentially useless in your specific situation—but we can't be certain. Furthermore, the stomach biopsy was insufficient; it is entirely possible that areas of intestinal metaplasia still exist but were missed by the biopsy. Keep in mind, intestinal metaplasia isn't always visible to the naked eye during the procedure. As I believe I've mentioned previously, having normal calprotectin levels—especially alongside a normal CRP and ESR—suggests there is a very low probability that your gastrointestinal issues are linked to inflammatory bowel disease.

To be perfectly honest, looking at the findings presented, it was difficult for me to reach any meaningful conclusion.

Thank you so much!

Does anyone know anything about VEGF markers? Like, how do they actually work, and is there any real benefit to getting those tests done?

Hey,

I have a question. Just got some blood work back. Wondering if anyone knows if these numbers look alright or not.

Potassium 4.1 (ref range 3.9 to 5.1)
Sodium 140 (ref range 137 to 146)
Calcium 2.55 (ref range 2.14 to 2.53)

Calcium is slightly elevated, so I'm not sure if that's a concern or not.

Thanks in advance.
Best,

Everything looks normal in the results. What was the motivation behind running these tests in the first place?

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Jose Doyle89 said:Results look clean. Why did you even bother getting this checked in the first place?

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That seems standard enough. They probably ran a few more tests on you, like liver panels and things like that, or maybe they just stuck to this.

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Jose Doyle89 said:That’s fine. They probably ran more tests, like liver panels and stuff, or maybe just this.

Well, they did a full blood count. My lipids and cholesterol are up, calcium is high, and the only thing that came back low was alkaline phosphatase. It was at 46, but it should be somewhere between 60 and 142.

I assume you've already done some digging online regarding alkaline levels—you know, looking into what it actually means when they come back low or high?
To start things off, I’d suggest getting on a regimen of vitamin B, zinc, and magnesium.

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Jose Doyle89 said:I assume you guys have all read about how alkaline levels fluctuate online when things go too low or too high?
Start taking some vitamin B, zinc, and magnesium to begin with.

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If I've got this right, it shows up when there's a vitamin deficiency?

That’s something you really have to weigh first, assuming there aren't any other symptoms piling up and your other lab results are looking relatively normal. Your doctor will give you the final word on the specifics of your situation, but you can certainly go ahead and take this. Besides, it isn't exactly a massive deviation from the norm.

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Jose Doyle89 said:You have to look at the big picture first. If there aren't other symptoms and everything else looks relatively normal, then you're probably fine. Your doctor will give you the final word on what to do, but this is something you can take. It isn't a massive deviation anyway.

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So the calcium levels are fine. I was just worried because I saw all kinds of stuff online about what happens once calcium hits 2.6 or higher.

Austin Harris71 said:So, this calcium level is fine. I was just getting worried because I saw people online making a huge deal out of anything 2.6 and above.

Calcium really needs to be north of 3.0 before you even start looking at other possibilities. Besides, you’d need to be experiencing actual symptoms for it to point toward anything specific. How old are you, and has a doctor actually sat down and reviewed these results with you? If there are kidney issues in the picture, that’s where the focus should probably be instead. Generally speaking, the lab work looks clean enough on its own, but without a physical exam or seeing your full medical history, there isn't much else to say.

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