Celiac Disease Diagnosis

(courtesy - Gut doctor)


No screening test is perfect, and that the keys to confirming the diagnosis of CELIAC DISEASE remain a small intestinal biopsy combined with the patient’s subsequent clinical response to a gluten-free diet.
The tTG IgA ELISA test is highly sensitive and specific. The tTG assay correlates well with EMA-IgA and biopsy. TTG false positivity has been described in patients with both type I diabetes and autoimmune hepatitis. Theoretically, it can also be falsely positive in other autoimmune disease.
The antiendomysial IgA antibody is an excellent screening test for CELIAC DISEASE, with both a high sensitivity and specificity. It is considered the gold standard of antibodies. However, the subjective nature of this test (someone still needs to look at the slide under a microscope) may lead to false negative values and unacceptable variability between laboratories. Its major drawbacks are that it may be falsely negative in young children, in patients with IgA deficiency and a lesser degree of villous atrophy, and in the hands of an inexperienced laboratory.