Wondering what’s involved with the why & how behind getting screened & tested for celiac disease? Here’s what you need to know to help demystify the process you must take before going gluten-free for good!
Now that we know what celiac disease is, that it’s not a food allergy, and the symptoms, now it’s time to learn just why and how celiac disease screening and testing happens. The key here is BEFORE, I repeat, BEFORE you go gluten-free, the only way to ever know and get an accurate, credible, medical diagnosis is to get tested while gluten is still being consumed and possibly wreaking havoc on the system. If you start your gluten-free lifestyle before you get this diagnosis by a professional, forget about getting special accommodations when they are truly needed (i.e. in college, school, the workplace).
There are two essential parts to being tested. The first is Serologic Blood Panels, if those yield positive or questionable results, then the small intestinal biopsy will be performed to confirm a celiac diagnosis. After those two are run, it is beneficial to get the genetic test. This will not only confirm further for you, but also be good for your first degree family members (if they get tested as well) to see if they carry the “celiac genes” and then may want to get blood panels as well.
Below is an in depth look and more information on these 3 tests that will be preformed by your doctor or gastroenterologist upon your urging or their recommendation:
Serologic Blood Tests:
Indicates antibodies present in celiac disease as part of the IgA or IgG (immunoglobulin A/G) panel. If a patient has an IgA deficiency, (when IgA-EMA and IgA-tTG are negative and determined by the AGA test, but celiac disease is still strongly suspected), IgG panels can be run instead. For these panels you MUST be consuming gluten for anything to show up accurate. These test panels can vary from lab to lab as to which ones are run.
EMA (Anti-Endomysial) – Most accurate indicator of celiac disease (99%).
tTG (Anti-Tissue Transglutaminase) – This is an enzyme-linked test and may lead to better results in those with more damage and sensitivity, but is still a very accurate indicator of (93%).
DGP (Deamidated Gliadin Peptide) – This is the newest antibody test and research is still being done. Less is known about its accuracy and due to its cost, EMA and tTG are still run first, however this test is usually run if IgA deficiency is present.
Small Intestinal Biopsy:
If the Serologic Blood Tests point to celiac disease in the patient, it is then typical and recommended to get a biopsy so the small intestine before any modifications to diet are made. The biopsy is a simple outpatient procedure done by your gastroenterologist. If damage is found, along with the positive blood tests, which on indicate the possibility of celiac, this will “confirm” the presence of a celiac disease and complete the diagnosis.
- If Dermatitis Herpetiformis is present on the patient (the skin manifestation of celiac disease), a biopsy of the skin can also be done.
There are two genes that are associated with celiac disease. You can either have one or both and they are HLA DQ2 and DQ8. However, 40% of people carry these genes so it DOES NOT mean that you have celiac disease nor will you ever develop it. Only about 1% of people do have true celiac disease, but of that 1%, they all carry one of both of the 2 genes. This test can be done via blood or saliva, after the 2 above tests have been run. The genetic test is helpful in screening the rest of a celiac’s family (first degree relatives) or as a last ditch effort if the suspected celiac patient is already on a gluten-free diet or the other blood tests and biopsy were not easily confirmed.
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