When Is It Ordered
Celiac disease tests are ordered when someone has signs and symptoms suggesting celiac disease, malnutrition, and/or malabsorption. The symptoms are often nonspecific and variable, making the disease difficult to spot. The symptoms may, for a time, be mild and go unnoticed and then progressively worsen or occur sporadically. The condition can affect different parts of the body.
Digestive signs and symptoms may include:
- Abdominal pain and distension
Can My Doctor Use Imaware Results
Yes. All of our tests are performed by CLIA-certified labs, the gold standard in lab testing quality regulation. Within your results report you will also find detailed information intended for your healthcare professional. They can use this information to interpret your test results clearly. To see an example of this, you can request a sample report at the top of this page.
What Is A Strongly Positive Blood Test
As you can see above with the 4 out of 5 Rule, one of the criteria is a strongly positive blood test. How should that be defined?
A variety of studies put various values on the positive predictive value, or PPV, of the tTG blood test.
In pediatric populations, its been shown that a tTG over 100 U/mL is predictive of severe villous atrophy of the lining of the small intestine. This severity is called a Marsh 3 classification after the British doctor who established it. Well talk more about that in a moment.
Studies looking at patients older than 15 years put the PPV at 100% when tTG tested at over 30 U/mL.
The researchers noted a discrepancy however with strongly positive tTG values with normal or near-normal small intestinal linings, or Marsh 1 findings. Did that mean those patients did not have celiac disease? Not necessarily.
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Gluten Sensitivity Is A Valid Condition
Non-celiac gluten sensitivity is the medical term used to describe someone who doesnt have celiac disease but gets sick from eating gluten. It is a real and valid condition.
There is currently no scientifically proven lab test to diagnose gluten sensitivity. It can only be diagnosed through an elimination diet. You must first test for celiac disease. If the results are negative, gluten is eliminated from the diet, including sources of cross-contamination. If a gluten-free diet resolves symptoms, the doctor may conclude you have non-celiac gluten sensitivity.
It is then important to determine the reason for the gluten sensitivity. Do you need a low FODMAP diet? A wheat-free diet? You may not need a strict gluten-free diet. You may not have to worry about cross-contamination. If the problem is a FODMAP intolerance, the diet is a low FODMAP diet, not a gluten-free diet. And, gluten cross-contamination is not usually an issue.
If you start with a strict gluten-free diet without testing, you are doing yourself a disservice. The long-term dietary implications may be similar or vastly different for celiac disease and gluten sensitivity.
Testing for celiac disease is the first step in appropriately diagnosing non-celiac gluten sensitivity.
Gluten intolerance is a term that describes both celiac disease and non-celiac gluten sensitivity. The general public uses the terms gluten intolerance and gluten sensitivity interchangeably.
Who Should Be Tested For Celiac Disease And Gluten Intolerance
Anyone who has noticed any or all of the symptoms listed above should be screened for celiac disease and gluten intolerance. Since these disorders tend to run in families, anyone who has a close relative who has been diagnosed with celiac or gluten sensitivity should also be tested. Children who are small in stature, have ADHD, failure to thrive, or delayed puberty should also be tested, as these can be signs of poor nutrient absorption associated with celiac disease or gluten intolerance.
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How Is The Genetic Predisposition For Celiac Disease Inherited
Inheriting the genes for celiac disease occurs differently than the manner in which many genetic traits are passed on. We are accustomed to thinking in terms of dominant or recessive genes, which are inherited from both parents and form sets to determine hair color, height, and other human health characteristics. In fact, even though the DQ2 and DQ8 genes are passed on similarly, having them is not sufficient to determine the occurrence of the disease, even if the genes are inherited from both parents.
Because 35% of the American population have either the DQ2 or DQ8 gene, it is possible for two affected people to marry each other. The genes can be passed on by males as well as females. Therefore, one persons gene test doesnt necessarily mean that the other side of the family is not affected as well.
Testing For Gluten Intolerance & Celiac Disease
Testing for Celiac disease is relatively easy and cost-effective and more available than testing for gluten intolerance.
It’s estimated that anywhere from 1-3% of patients in the United States suffers from Celiac disease.
As a provider, I frequently check for Celiac antibodies in those patients who have autoimmune diseases and tend to uncover gluten intolerance in a surprising number of patients.
If you believe that you may be suffering from Gluten intolerance it is worth getting tested for Celiac disease.
The presence of these antibodies doesn’t mean you 100% have the condition but it can give you an idea of what is happening in your body and therefore help target treatment.
You can do this by assessing the following labs:
- IgA & IgG anti-gliadin antibodies
- IgA endomysial antibodies
- And genetic tests for HLA DQ2 and HLA DQ8
Positive tests stand out like a sore thumb and aren’t likely to be missed.
You can see an example of a positive test below:
This patient has positive antibodies to IgA tissue transglutaminase antibodies as well as IgA Gliadin peptide antibodies indicating a likely issue with gluten metabolism in the body.
If you see a result such as this then your next step should be the removal of gluten from your diet.
Advanced Gluten Intolerance Testing
Beyond these tests, there are other tests available to assess for other fractions of the gluten molecule.
These include tests to casein, cow’s milk, milk chocolate, whey protein, millet, oats, and even yeast.
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Diagnosing Those Who Are Gluten Sensitive
It is important to understand that gluten sensitivity is not a disease. It is a state of genetics. Much like an allergy, avoid the food, avoid the disease or symptoms that the food causes. That being said, genetic testing is the only accurate and early way to determine whether a person should avoid gluten. Gluten induced damage can start early in life as inflammation . It can take years before the damage manifests as illness. Early genetic testing is the new gold standard.
So how does one go about getting genetically tested for Celiacs? I was given a blood test and told I was fine but still continued to have symptoms . These last eight months things have gotten a lot worse. I had an endoscopy and a colonoscopy and was told everything is fine, you just have IBS.
I dont even know where to start to just see if I might be sensitive. Lately pretty much everything makes my stomach ache, gives me the runs. Ive always had dizzy headaches and two years ago diagnosed with diabetes. Its just so confusing.
This is great news to get rid of a gold standard test that does not work. However, a person with non-celiac gluten sensitivity does not always have a positive genetic test. My 14 yr old has been gluten free for 4 years without being sick. Her genetic test was negative as well as blood testing. Maybe Enterolab has the answer with stool testing and should be looked into more.
Why An Intestinal Biopsy
An intestinal biopsy is considered the gold standard for diagnosis because it will tell you if you have celiac disease, if your symptoms improve on a gluten-free diet due to a placebo effect or if you have a different gastrointestinal disorder or sensitivity which responds to change in your diet.
If the results of the antibody or genetic screening tests are positive, your doctor may suggest an endoscopic biopsy of your small intestine. An endoscopy is a procedure that allows your physician to see what is going on inside your GI tract. A scope is inserted through the mouth and down the esophagus, stomach and small intestine, giving the physician a clear view and the option of taking a sample of the tissue.
This is usually an outpatient procedure. Samples of the lining of the small intestine will be studied under a microscope to look for damage and inflammation due to celiac disease. It is recommended that the doctor take at least 4-6 duodenal samples from the second part of duodenum and the duodenal bulb, in order to obtain an accurate diagnosis.
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Gluten Needed Before Tests
Genetic Testing May Help To Confirm A Diagnosis
People who have Celiac disease also carry the HLA-DQ2 or HLA-DQ8 genes or both of them. The only problem is that 40% of the general population also carries one or both of these genes. This means testing positive on this gluten intolerance blood test does not mean someone will develop Celiac disease, but the results can be used with other test results to put together a diagnostic picture.
Genetic testing may also become a first priority for a gluten intolerance diagnosis if the individual involved has already switched over to a gluten-free diet. No antibodies against gluten can be produced without its consumption, but the genetic testing can at least determine if further testing may be required. This specific test can be done with a cheek swab, with saliva, or through the use of a blood test.
As a final resort, when all testing methods are inconclusive for gluten intolerance, a biopsy of the small intestine may be needed. This is the only current method of diagnosis Celiac disease. If the biopsy comes back as negative and there are no histamine results to gluten from allergy testing, then a gluten intolerance will be confirmed.
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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.
What Does The Intestinal Biopsy Show
- Density of intra-epithelial lymphocytes , which are white blood cells found in the immune system. More than 25 IELs per 100 epithelial cells is significant. Epithelial cells line your intestines and act as a barrier between the inside and the outside of your body.
- Crypt hyperplasia with a decreased villi/crypt ration. Crypts are grooves between the villi, which are the small fingerlike projections that line the small intestine and promote nutrient absorption. Crypt hyperplasia is when the grooves are elongated compared to a normal intestinal lining which has short crypts.
- Blunted or atrophic villi. This is a shrinking and flattening of the villi due to repeated gluten exposure.
- Mononuclear cell infiltration in the lamina propria. The lamina propria is a thin layer of loose connective tissue, which together with the epithelium forms the mucosa which stops pathogens from entering the body.
- Epithelial changes, including structural abnormalities in epithelial cells.
The endoscopy itself may show scalloping and/or flattening of dudodenal folds, fissuring over the folds, and a mosaic pattern of mucosa of folds.
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How Gluten Sensitivity Is Diagnosed
Getting a gluten sensitivity diagnosis isn’t a straightforward process. Medical research lends support to the idea that non-celiac gluten sensitivity is a real condition, but there are healthcare providers who do not believe in its existence. Furthermore, there is no consensus on how to test for gluten sensitivity or what results of tests used by some when working toward a diagnosis actually mean.
Keep in mind that most healthcare providers recommend you undergo celiac disease testingfirst if you suspect you are reacting to gluten. However, if your celiac disease test results are negative, gluten sensitivity tests may provide you with evidence that your body is mounting a response to gluten.
A Celiac Diagnosis Alerts Doctors
Children with celiac disease may have poor growth, behavior problems, headaches, or dozens of other possible symptoms. They may not have the classic celiac profile that leads most doctors to consider a celiac disease.
If you have a formal diagnosis of celiac disease yourself, it should prompt the pediatrician to test your child for celiac disease as a possible cause of your childs symptoms. If the doctor doesnt suggest testing, you can request it.
Family members may be struggling with symptoms related to celiac disease that have not raised concern for testing. Celiac disease has over 300 symptoms-most are not related to digestion. If a family member has celiac disease-these symptoms may be more closely considered.
If you start yourself on a gluten-free diet without testing, celiac testing is not accurate. You will now be labeled gluten-intolerant. Some people, including some physicians, consider gluten intolerance a fad. Your childs doctor may be less inclined to test your family member or child if you do not have a formal diagnosis.
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What Is The Difference Between Celiac Disease And An Allergy To Wheat And Other Grains
Allergies involve hypersensitivity reactions and the production of specific immunoglobulin E antibodies directed against grains such as wheat and rye. These antibodies may cause some symptoms similar to those caused by celiac disease, but they will only do so for a short time after you eat the food to which you are allergic or sensitive to. The reaction may be mild or severe, but it is limited and does not cause damage to the lining of your intestine the way that celiac disease does. If you feel that you may have a wheat or other grain allergy, talk to your healthcare practitioner about getting tested for these allergen-specific IgE antibodies.
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.
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