How To Test For Celiac Disease
Testing for celiac disease is something that you should discuss with your doctor. Routine testing is not recommended unless you have symptoms of the disease or you are at increased risk of developing them. For example, if you have a first degree relative with the condition such as a parent, sibling or child, you may be at increased risk. Moreover, some symptoms in children and adults warrant testing. These include persistent unexplained gastrointestinal symptoms such as being sick, weight loss, mouth ulcers, type 1 diabetes and unexplained iron deficiency anaemia.
Testing involves having blood tests to identify whether or not you may have the condition, followed by a biopsy to confirm the diagnosis. During the testing process, you will need to consume gluten containing foods to ensure that the test results are accurate.In fact, avoiding gluten prior to your blood test could lead to an inaccurate result. In addition, you should not self-administer a gluten-free diet until the diagnosis of celiac disease is confirmed, even if your blood tests results are positive. If your blood tests show celiac disease antibodies, your doctor will refer you to get a biopsy for your gut cells.
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The Ttg Iga Biopsy Bias
There is a rightful bias against recommending patients undergo a biopsy of the small intestine because it is such an invasive procedure, and I cited this 2017 study above from the Journal Gastroenterology, which found the IgA testing so predictive as to make biopsy unnecessary.
However, it is still generally agreed that only through a biopsy can a diagnosis of celiac can be confirmed.
If you havent been eating gluten, your blood may not show tTG antibodies, and your body may have healed to the point where damage to the small intestine abates as well. Since tTG IgA is the gold standard, the lack of these antibodies likely wont result in the recommendation of a biopsy. However, this does not mean that gluten is not causing some kind of autoimmune reaction. Remember, the tTG antibodies are elevated as the result of damage to the small intestine, and the only way to confirm that damage is biopsy, which most wont do.
In light of this fact, there are people out there who have reactions to wheat, and who are not diagnosed as celiac, but who can credibly say they are gluten sensitive because they have the blood work to prove it. Where serum IgA levels are low, tTG IgG can be a potential sign of celiac.3
Gluten And Mood Disorders
Schizophrenia and depression have been linked to gluten sensitivity. In fact, gluten sensitivity seems to be a causative factor for schizophrenia in patients genetically susceptible to the condition.
In one study, A drastic reduction, if not full remission, of schizophrenic symptoms after initiation of gluten withdrawal has been noted in a variety of studies.
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Are You Dairy Or Gluten Intolerant Is It Possible To Be Intolerant To Both
There are different symptoms a person may have when they find out they are intolerant to either gluten or dairy. Knowing the signs will help to ensure that you make the necessary dietary changes early on. The following guide will help to understand the types of intolerances and how to identify them.
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Wheat Allergy Blood Test Ige
A wheat allergy blood test, IgE is a qualitative allergen specific IgE blood test to determine if you are suffering from a hypersensitivity to wheat.
Also Known As: Bread Wheat
Methodology:
2-4 days. May take longer based on weather, holiday or lab delays.
Also Known As: Bread Wheat
Methodology:
5-7 Days. May take longer based on weather, holiday or lab delays.
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Why Is It So Difficult To Receive A Diagnosis
In medicine, there are many things that arent totally clear-cut. Doctors must use judgment and evaluate your symptoms along with lab test results to come to the best diagnosis.
Yes, sometimes the results are obvious theres no argument what is occurring, but more often there are some gray areas and one needs to compile evidence and findings to best help ones patient.
Laboratory tests for celiac disease are no different. Sometimes they are obvious other times not. But the time involved to receive a celiac diagnosis stands out for the ridiculously lengthy period it takes. When the why for someones symptoms is celiac disease, the average diagnosis time is close to a decade.
The varied presentations of celiac disease and similarities of its symptoms with other diseases often lead to misdiagnoses such as irritable bowel syndrome, diverticular disease, gastric ulcers, allergies, chronic fatigue syndrome, or fibromyalgia.
Individuals frequently see numerous physicians before receiving a correct diagnosis. Published in Digestive Diseases and Sciences, The Canadian Celiac Health Survey revealed 37% of respondents had consulted two or more family physicians, 27% saw three or more physicians and 14% consulted two or more gastroenterologists before reaching a diagnosis of celiac disease. The mean delay in diagnosis was 11.7 years after the onset of the symptoms.
How To Determine If Your Child Is Gluten Intolerant Or Has A Wheat Allergy
Once a blood test has confirmed that your child does not have celiac disease, the best way to determine a food sensitivityand specifically, a gluten intolerance or wheat allergyis to eliminate gluten from their diet and monitor how this affects their symptoms. Of course, this should always be done under the supervision of your childs doctor, and youll want to seek their medical advice in order to reach the right diagnosis.
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Gluten And Lactose Intolerance
When a coeliac is undiagnosed, they may believe they have an intolerance to only lactose, which is found in dairy products. Once a coeliac is diagnosed and begins to follow a gluten free diet, after some time they will lose the intolerance to lactose. That is not to say all lactose intolerant people have gluten intolerance but the symptoms of both are quite similar. Bloating, stomach cramps, leaky gut syndrome, acid reflux, skin problems, nausea and diarrhoea are all symptoms of dairy intolerance and are shared symptoms with coeliac. Other signs of gluten intolerance include infertility, hormone imbalance, chronic fatigue, anxiety and depression. In more serious cases consumption of gluten or wheat can lead to hospitalisation or even death. Your doctor or nutritional therapist will be able to run tests to determine which you have a problem with, or if you should avoid both.
What About Gluten Sensitivity
Gluten sensitivity, or non-celiac gluten sensitivity, as it has come to be known, is more troublesome because there isnt an agreed-upon method of diagnosis there is no accepted lab test that definitively diagnoses it.
Further, many traditional doctors and gastroenterologists do not realize that a patient testing negative for celiac disease could still be suffering from gluten sensitivity.
Gluten sensitivity has been placed in the category of diagnosis by exclusion. Meaning, a patient who demonstrates the symptoms of the condition is only diagnosed with gluten sensitivity once it has been successfully ruled out that they do not have celiac disease or a wheat allergy.
Many doctors use the AGA- IgG test to evaluate for gluten sensitivity, but it may not be the best approach. A 2015 study published in Clinica Chimica Acta The International Journal of Clinical Chemistry found the test to not work very well. They compared blood test results from people with suspected non-celiac gluten sensitivity, people with celiac disease, and those with neither condition.
They concluded that the AGA-IgG blood test isnt sensitive for non-celiac gluten sensitivity, meaning it misses some who actually do have the condition. Their conclusion was the AGA-IgG test results can help with diagnosis, the researchers said, but only if the results are combined with other factors.
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Do I Need To Follow A Gluten
If you have asymptomatic celiac disease, it is recommended that you follow a gluten-free diet. You will still have damaged villi in your intestines and you may have malabsorption problems that are causing silent conditions such as osteoporosis. If you have doubts about the accuracy of your diagnosis, you may want to work with your health practitioner to verify the findings.
Endoscopy And Intestinal Biopsy
An intestinal biopsy is considered the gold standard for celiac disease diagnosis and can give you a definitive answer to your childs health problems.
The biopsy is taken during an upper gastrointestinal endoscopy, which is a very safe and routine procedure. Some preparations are needed, and your child may be lightly sedated during the procedure. The actual endoscopy only takes about 15 minutes.
During the endoscopy, a pediatric gastroenterologist will use a small flexible camera scope to examine your childs intestinal wall/lining. They will be looking for damage or flattening of the villi . This damage is the hallmark of celiac disease. A few biopsies will be taken for microscopic review to confirm your childs diagnosis.
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What Is Coeliac Disease And When Should Testing Be Considered
Coeliac disease is defined as an autoimmune enteropathy of the small intestine, caused by exposure to dietary gluten in genetically pre-disposed individuals. In susceptible individuals, gluten ingestion generates an inflammatory reaction predominantly centered in the upper parts of the small intestine. This mucosal injury will eventually reduce the intestinal absorptive area and interfere with uptake of micronutrients.2
Gluten Intolerance Wheat Allergy And Celiac Disease: Whats The Difference
There are many terms used to describe the different ways a body may respond to gluten. Some people are allergic to wheat, but that is not the same as a gluten allergy. In fact, there really is no such thing as a gluten allergy, and it is more accurate to refer to it as a gluten intolerance or non-celiac gluten sensitivity. Celiac disease, on the other hand, is a digestive condition that can be serious if not properly diagnosed or treated.
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If My Positive Antibody Test Suggests I May Have Celiac Disease How Do I Find Out For Sure
If antibody tests and/or symptoms suggest celiac disease, the physician needs to confirm the diagnosis by obtaining tiny pieces of tissue from the small intestine to check for damage to the villi. This is done in an endoscopic biopsy procedure. Under sedation, the physician eases a long, thin tube called an endoscope through the mouth and stomach into the small intestine, and then takes samples of the tissue using small instruments passed through the endoscope.
Even though the blood tests are quite accurate, they may occasionally produce false positive results or, less commonly, false negative results . Thus, biopsy of the small intestine is the only way to diagnose celiac disease.
How Should I Prepare For This Test
If you are not currently eating gluten regularly , you must add gluten back into your diet for 6-8 weeks before taking the celiac disease screening test. Do not take this test if you are currently following a gluten-free diet, as your results will not be accurate. If you have an allergy to wheat or experience a severe reaction when consuming any volume of gluten, please consult with a physician first.
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Gluten Free Societys Stance
The biopsy as a gold standard for the diagnosis of gluten intolerance is dead, but doctors keep trying to cling to its corpse!
Gastroenterologists continue to foolishly use the biopsy as a gold standard despite the fact that thousands of patients have successfully gone gluten free and eradicated their symptoms of disease. Not to mention that study after study has proven how inaccurate this testing really is.
Gluten Needed Before Tests
Youâll need to take some tests to find out if you have celiac disease. And for some of these tests to be accurate, youâll have to have some gluten in your diet.
If youâre on a gluten-free diet, your doctor may put you on a âgluten challengeâ plan before you take these tests. Youâll eat at least two servings of gluten every day for 8 weeks.
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What Causes Gluten Intolerance
The exact causes of gluten intolerance arent well understood. Some research shows that people may not be sensitive to gluten, but to a certain carbohydrate found in many foods. Their bodies dont absorb the carbohydrate as they should. It stays in their guts and ferments, causing sickness.
Other research suggests that wheat might affect the lining of some peoples digestive tracts. This lining usually keeps bacteria from leaking out of your intestines. But in people with a gluten intolerance, the lining may not work as it should, allowing bacteria into their blood or liver and causing inflammation.
What Is Genetic Testing And Who Can Benefit From It
DNA testing is available to determine whether or not an at-risk individual carries the genes responsible for the development of celiac disease. These genes are located on the HLA-class II complex and are called DQ2 and DQB, which in contemporary terms are named DQA1*05XX and DQB1*02XX for HLA-DQ2 and DQA1*03XX and DQB1*0302 for HLA-DQ8. Every case of celiac disease has been found to show these so-called haplotypes therefore, a negative gene test indicates that celiac disease cannot develop in that individual.
There are two main reasons for using the genetic test when evaluating an individual for celiac disease. The first case is to rule out celiac disease, which is a medical term that indicates an individual does not possess a necessary risk factor for the development of celiac disease, or does not have a genetic predisposition. Without this factor, it is impossible for someone with a negative gene test to develop celiac disease in the future. People who test negative for the gene would not be required to have regular antibody screening for the remainder of their lives. Children of an adult with celiac disease should have the gene test so the parents will know which children need close monitoring.
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How Is Gluten Intolerance Treated
Theres no cure for gluten intolerance. But most people find relief from symptoms by following a gluten-free diet. You should work with your healthcare provider and a dietitian to plan your diet.
You can also ask your healthcare provider about adding probiotics to your diet. Probiotics help increase the good bacteria in your gut. They may reduce symptoms of bloating, gas or constipation.
Some research suggests that taking certain enzymes may help you digest gluten. But experts are still investigating this treatment. Talk to your healthcare provider before taking any enzymes.
What Do We Know From This
A couple of things: 1) Ensure that when you are tested you receive a complete panel of tests, including all those mentioned above. Additionally, both the IgA and IgG versions should be included, especially for the AGA test. 2) When interpreting the tests, remember that you are doing more than just ruling out celiac disease.
For many doctors that is their goal.Despite international research knowledge to the contrary, many doctors still dont appreciate the existence of gluten sensitivity. While no single test is perfect, if youre suspecting celiac and you test positive for the classic celiac panel of tTGA, EmA, and DGP-AGA, then youve likely identified your condition. If you know that you do poorly with gluten and test positive for AGA, especially the IgG version, and negative for the rest of the celiac panel, you can feel more assured of a gluten sensitive diagnosis.
Some other tell-tale signs of gluten sensitivity, according to the researchers, are a varied clinical picture, meaning many symptoms occurring at the same time. And while many of these symptoms are similar to another disease, IBS, the authors warn against considering gluten sensitivity as a subtype of IBS. The extraintestinal symptoms so common with gluten sensitivity are not typically seen in those patients suffering from IBS, making the distinction clear, in these researchers opinion.
The common complaints associated with gluten sensitivity include:
abdominal pain, bloating, diarrhea, constipation
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