Diagnosis

Despite the growing awareness of celiac disease, the road to diagnosis can still be long and bumpy. The celiac iceberg hides under a sea of symptoms and manifestations that can confuse both the doctor and the patient. Specific blood tests (serological testing) are an important indication of whether or not you have celiac disease.

Testing for Celiac Disease

Blood Test: The panel of blood tests that are very specific and sensitive for the diagnosis of celiac disease includes:

  • IgA Endomysial Antibodies (EMA): Highly specific marker for celiac disease.
  • IgA Tissue Transglutaminase (tTG): Very specific marker for celiac disease.
  • IgG Tissue Transglutaminase: Necessary to diagnose celiac disease in IgA-deficient individuals.
  • Total IgA Antibodies: Will identify celiac disease in symptomatic patients who are IgA deficient.

Intestinal Biopsy: The only definitive means of accurately diagnosing celiac disease is by an intestinal biopsy, the gold standard for diagnosis.

Celiac disease does not necessarily cause uniform damage. Therefore, gastroenterologists must take samples from various sections of the mucosa for confirmation of the diagnosis.

Besides celiac disease, certain other causes for a positive biopsy, i.e. flattened villi, include: HIV disease, Tropical sprue, Giardiasis, Crohn’s disease, Organ transplant reaction, Gastroenteritis. These false positive causes must be ruled out by a physician.

Other Tests:

– Skin Biopsy (to rule out DH)
– Anti Gliadin antibodies
– IgG food intolerance test
– Blood dot test
– Faecal Test
– Saliva Test
– Breath test
– Gluten challenge
– Genetic test – HLA typing

Case for mass screening: Celiac disease is unusual, but it’s no longer rare,” says Dr. Murray. “Something has changed in our envyironment to make it much more common. Until recently, the standard approach to finding celiac disease has been to wait for people to complain of symptoms and to come to the doctor for investigation. This study suggests that we may need to consider looking for celiac disease in the general population, more like we do in testing for cholesterol or blood pressure.