Celiac Disease: Exams And Tests

Content provided by Healthwise

Exams and Tests

In many cases of celiac disease, other conditions with similar symptoms, such as food intolerance or irritable bowel syndrome, are first suspected. Often, celiac disease is only considered after the initial diagnosis of another condition is rejected because treatments are not effective.

A medical history and physical examination and lab tests often point to celiac disease. The diagnosis is confirmed with a small intestine biopsy collected during an endoscopy. For this procedure, an endoscope is guided down a person's throat to the small intestine.

Blood antibody tests

Celiac disease triggers the immune system to produce certain antibodies. If celiac disease is suspected, your doctor will order certain blood tests to detect and measure specific antibodies.

• IgAtTG: Immunoglobulin A (IgA) and tissue transglutaminase (tTG) antibody
• IgAEMA: Immunoglobulin A (IgA) and antiendomysial antibody (EMA)

If either or both of these tests are positive, your doctor may perform a biopsy of the small intestine to confirm a diagnosis of celiac disease.

Endoscopy

A biopsy taken during an upper gastrointestinal endoscopy may be done to confirm celiac disease after antibody tests are positive. Sometimes a biopsy detects celiac disease when a person is being tested for another condition.

A biopsy should be done when you or your child is eating a diet that includes gluten. If the biopsy shows signs of celiac disease (such as abnormal villi and inflammation in the small intestine), a gluten-free diet will be recommended. If the symptoms go away on the gluten-free diet and antibody tests are normal, a diagnosis of celiac disease is confirmed.

If you or your child is on a gluten-free diet before a biopsy is done, you may have to eat a prescribed amount of gluten before the test.

Other tests

Tests for malabsorption may be done when celiac disease is suspected. These tests may include:

• A stool analysis to evaluate fat content. A 3-day collection of stools usually shows higher-than-normal fat content in people who have celiac disease that is causing symptoms.
• A bone density test. This may be done to see if you have problems such as osteomalacia (known as rickets in children) or osteoporosis, which may develop in some people with celiac disease.
• An upper GI series, which may detect intestinal problems but does not give precise information to guide diagnosis or treatment for celiac disease. An upper GI series is rarely needed when celiac disease is suspected.

Certain blood tests may be done to evaluate complications from celiac disease. For example, a complete blood count (CBC) may be done to test for anemia. Also, a chemistry screen, which tests a blood sample for sodium, potassium, chloride, and carbon dioxide levels, may be done to identify whether you or your child has an electrolyte imbalance.

If a diagnosis of celiac disease is suspected but symptoms don't improve with a gluten-free diet, further testing for other conditions and diseases, such as Crohn's disease or cystic fibrosis, may be needed.

Prepare your child for exams and tests that are needed to diagnose suspected celiac disease. Doing so will help your child understand what to expect and can help reduce fears.

Early Detection

Blood tests to measure antibodies, such as immunoglobulin A tissue transglutaminase (IgAtTG) or the immunoglobulin A antiendomysial antibody (IgAEMA), can be useful screening tools for people who are at increased risk for having celiac disease. This includes people with a family history of celiac disease or those who have type 1 diabetes, Down syndrome, dermatitis herpetiformis, an autoimmune disease, unexplained anemia, abnormal liver function tests not caused by another disease, or unexplained osteoporosis. Talk to your doctor if you think you or your child should be screened for celiac disease.

Last updated:	June 23, 2008
Author:	Monica Rhodes
Reviewed By:	Michael J. Sexton, MD - Pediatrics, Jerry S. Trier, MD - Gastroenterology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC