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Screening: First Step to Finding Celiac Disease

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We found this article on the Celiac Disease Foundation website (Celiac.org)

Read the article below and find out the first steps on how to find out if you have celiac disease. Also remember to always consult a doctor who is experienced with celiac disease to ensure proper diagnosis and treatment.

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“There are two steps to finding out if you have celiac disease: screening and diagnosis.

Why get screened?

Celiac disease is a lifelong autoimmune disorder that affects multiple parts of your body which can lead to other serious illnesses whether or not you are on a gluten-free diet.

 Who should get screened?

  1. Children older than 3 and adults experiencing symptoms of celiac disease
  2. First-degree relatives of people with celiac disease (parent, child, sibling)
  3. Any individual with a related autoimmune disorder (Type 1 diabetes, chronic liver disease, Hashimoto’s thyroiditis, psoriatic or rheumatoid arthritis and heart failure)

There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.

IMPORTANT:  You must NOT be on a gluten-free diet.  If you are on a gluten-free diet, CDF’s medical experts recommend a “Gluten Challenge” – daily consumption of gluten equivalent to at least 4 slices of bread for one to three months followed by an endoscopic biopsy with no serology testing.

The First Step:  tTG-IgA Test

The most sensitive and commonly used, whether symptoms are present or not, is the tTG-IgA test.

Tissue Transglutaminase Antibodies (tTG-IgA) – The tTG-IgA test will be positive in about 98% of patients with celiac disease who are on a gluten- containing diet. This is called the test’s sensitivity.  The same test will come back negative in about 95% of healthy people without celiac disease. This is called the test’s specificity.  There is a risk of a false positive especially for people with associated autoimmune disorders like Type 1 diabetes, chronic liver disease, Hashimoto’s thyroiditis, psoriatic or rheumatoid arthritis and heart failure, who do not have celiac disease.

There are other antibody tests available to double-check for potential false positives or false negatives.

Other tests:

  • IgA Endomysial antibody (EMA): It has a specificity of almost 100%, but about 5-10% of people with celiac disease do not have a positive EMA test.  It is also very expensive in comparison to the tTG-IgA.  It is usually reserved for difficult to diagnose patients.
  • Total serum IgA: This test is used to check for IgA deficiency, a harmless condition associated with celiac disease that can cause a false negative tTG-IgA or EMA result.
  • Deaminated gliadin peptide (DGP IgA and IgG): This test can be used to further screen for celiac disease in individuals with IgA deficiency or people who test negative for tTg or EMA antibodies.

While it is very rare, it is possible for someone with celiac disease to have negative antibody test results. If your tests were negative, but you continue to experience symptoms, consult your physician and undergo further medical evaluation.


Genetic Testing

People with celiac disease carry one or both of the HLA DQ2 and DQ8 genes.  So do up to 40% of all people. Since only 1% of us has celiac disease, carrying HLA DQ2 or DQ8 is not a diagnosis of celiac disease nor does it mean you will ever develop celiac disease.

Genetic testing can be used to rule out celiac disease when a patient is already on a gluten-free diet or test results are inconclusive, and to encourage first degree relatives to get antibody testing (every 3 years or immediately if symptoms develop). Genetic testing can be done by blood test, saliva test or cheek swab.


Celiac Disease Foundation can help you find the right doctor to discuss symptoms, diagnose, and treat celiac disease. Please refer to our CDF Healthcare Practitioner Directory for a listing of experienced healthcare professionals.”

 

Original Source: https://celiac.org/celiac-disease/diagnosing-celiac-disease/screening/#GsmB5DwyAqoiK7F9.99

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