Diagnosis
Despite growing awareness of celiac disease, the road to diagnosis can still be long and bumpy. The "celiac iceberg" hides under a sea of symptoms that can confuse both doctor and patient. Specific blood tests (serology) are an important indicator of whether or not you have celiac disease.
Important: keep eating gluten until testing is complete. Starting a gluten-free diet first can make the tests falsely negative.
Blood tests
The panel of blood tests that are very specific and sensitive for celiac disease includes:
- IgA Endomysial Antibodies (EMA) — a highly specific marker for celiac disease.
- IgA Tissue Transglutaminase (tTG) — a very specific marker for celiac disease.
- IgG Tissue Transglutaminase — needed to diagnose celiac disease in people who are IgA-deficient.
- Total IgA — identifies symptomatic patients who are IgA-deficient.
Intestinal biopsy
The only definitive way to diagnose celiac disease is an intestinal biopsy — the gold standard.
Celiac disease doesn't always damage the gut evenly, so gastroenterologists must take samples from several sections of the mucosa to confirm the diagnosis.
Other causes of flattened villi on a biopsy include HIV disease, tropical sprue, giardiasis, Crohn's disease, organ transplant reaction and gastroenteritis. A physician must rule these out.
Other tests
- Skin biopsy (to rule out dermatitis herpetiformis)
- Anti-gliadin antibodies
- IgG food intolerance test
- Blood dot test
- Faecal test
- Saliva test
- Breath test
- Gluten challenge
- Genetic test — HLA typing
The case for mass screening
"Celiac disease is unusual, but it's no longer rare. Something has changed in our environment 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 come to the doctor. 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."
— Dr. Murray
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