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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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 Posted: Thu Jan 13, 2005 7:46 pm Post subject: Celiac Blood tests & more diagnostic info |
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Doctors will usually start with a set of blood tests called a Celiac Panel that should consist of the tests below. If the panel does not include all tests, you may not get the entire picture.
Please request your doctor to run ALL of these tests. Not all Doctors will know about Celiac Disease (CD) and may be unfamiliar with proper testing. This is where educating yourself becomes important.
You must be consuming gluten in order for these tests to be as accurate as they can be. Do not go gluten free (GF) before these tests are done.
If the blood tests come back positive, they may want to scope you to check for intestinal damage (the gold standard for Celiac diagnosis).
A complete Celiac Blood Panel:
Antigliadin IgA and IgG*
May indicate Non Celiac Gluten Sensitivity. More info on NCGS
Anti-tissue Transglutaminase Antibody (tTG) IgA and Anti-endomysial (EMA)
An indicator of villi damage [slight damage is not always detected].
These tests are highly specific to CD.
However, autoimmune diseases can skew the results of these tests
| University of Chicago CD Center wrote: | It is important to note that some people with Type 1 Diabetes, Hashimoto’s thyroiditis and autoimmune liver conditions can have a falsely positive tissue transglutaminase test. For this reason, it is important that tTG test results in people with these conditions be checked with the EMA test. The physician may nevertheless want to obtain an intestinal biopsy if clinically indicated, even if EMA are negative.
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http://www.celiacdiseasecenter.columbia.edu/C_Doctors/C05-Testing.htm
| Quote: | Causes of false positive celiac serologic tests
The endomysial antibody test is virtually 100% specific for celiac disease. However anti-tTG has been reported to be positive in the presence of liver disease, especially cirrhosis [33], diabetes [34, 35] and severe heart failure [36], as well as arthritis [37] and various autoimmune disorders [38]. The use of human tTG as the antigen in the test kit adds some greater specificity. Antigliadin antibodies may be present in inflammatory bowel disease [39], collagen vascular disease [40], and in many healthy people as well [41]. |
Total serum IgA
Rules out IgA deficiency. This must be run to ensure proper IgA test results
Anti-reticulin IgA
Rarely used but, a very thorough doctor will include this
Additional Testing
Due to the nature of Celiac Disease, it very common to find nutritional deficiencies. It's important to know this information as well.
Dr. Peter Green [world renowned CD expert] suggests this:
http://www.enabling.org/ia/celiac/medcare.html
| Quote: | | Basic blood work is also included in the initial assessment. Such things as anemia and liver function need to be looked for. But it's very important to go further than that, and knowledge of the physiology of the small intestine should lead a physician to measure those nutrients that could be malabsorbed. Celiac Disease involves the small intestine, where iron, folic acid, calcium, fat soluble vitamins (Vitamins K, A, D, and E) and zinc are absorbed. These nutrients should be measured in the initial assessment and also during the course of the illness. Physicians will see patients who present with malabsorption of just one of these nutrients. If they are aware of the consequences of all these nutrient deficiencies, it will help them consider Celiac Disease as a possible diagnosis. |
Initial Assessment and Follow-up Care of Celiac Patients, by Peter Green, MD, summarized by Sue Goldstein
Even though it's not in this list - B12 should be checked as well.
More info on Diagnostic Testing:
Diagnostic Testing can be found in the The Gluten File
Clan Thompson's Testing and their Results. This is a really great resource. Please, spend some time looking this over.
Prometheus Labs CeliaPlus. Prometheus Labs is a respected and well known lab for processing Celiac Blood Panels. Note: You will be asked if you are medical professional. Of course you are! 
Gluten Intolerance Group - Celiac Disease Diagnosis
American Celiac Disease Alliance - Diagnosis
| Quote: | What are the different antibody tests available? Can there be errors in testing?
The blood tests can be divided into 2 different types of antibodies: those which are “anti-gluten”, and those that “anti-self”. The “anti-gluten” antibodies are the anti-gliadin IgG and IgA. Ig stands for “immunoglobulin” or “antibody”. The “anti-self” antibodies are anti-endomysial IgA and anti-tissue transglutaminase IgA.
***
Antigliadin antibodies
The antigliadin antibodies IgG and IgA recognize a small piece of the gluten protein called gliadin. These antibodies became available during the late 1970’s and were the first step towards recognizing CELIAC DISEASE as an autoimmune disorder. Antigliadin IgG has good sensitivity, while antigliadin IgA has good specificity, and therefore their combined use provided the first reliable screening test for CELIAC DISEASE.
Thanks to Cruelshoes/Colleen for suggesting this be broken out! |
Celiac Disease Center at Columbia University
| Quote: |
Seronegative celiac disease
Both the anti-tTG and the EMA titers correlate with the severity of villous atrophy [26-29]. As a result in the presence of partial villous atrophy either antibody may be negative. In addition the mode of presentation of the celiac disease, i.e. presence of silent or subclinical celiac disease may be associated with a negative EMA [30]. Clinically seronegative celiac disease is similar to sero-positive celiac disease [23, 28] In view of the possibility of the presence of celiac disease in the absence of a positive anti-tTG or endomysial antibody the presence of a positive IgA AGA should prompt a biopsy [13]. Several studies have demonstrated that reliance on either anti-tTG or endomysial antibody as a single test will underestimate the prevalence of celiac disease [23, 25, 31, 32].
| Quote: | Positive serologic tests in the presence of a normal biopsy
This situation occasionally arises. The presence of a positive EMA with a normal biopsy indicates either the presence of celiac disease that was not detected in the biopsy, either because of too few pieces being taken or misinterpretation. The biopsy should be reviewed by an expert gastrointestinal pathologist. If it is considered to be truly a normal biopsy the patient may well have latent celiac disease and will probably develop the disease at a later date. |
Thanks to Cruelshoes/Colleen for suggesting this be broken out! |
Testing in children:
http://www.ncbi.nlm.nih.gov/pubmed/18852634?dopt=AbstractPlus
| Quote: | OBJECTIVES: The aim was to investigate age-dependent serum levels and occurrence of elevated celiac disease (CD)-related antibodies in young children, to define the optimal serological procedure when selecting for small intestinal biopsy. PATIENTS AND METHODS: Included were 428 children with biopsy verified CD (median age 16 months; range 7.5 months-14 years) and 216 controls (median age 2.7 years; range 8.5 months-14.6 years). Immunoglobulin (Ig) A antibodies against gliadin (AGA-IgA), tissue transglutaminase (tTG-IgA), and endomysium (EMA-IgA) were analysed. RESULTS: Increased serum AGA-IgA levels were found in 411 of 428 CD cases, tTG-IgA in 385 of 428, and EMA-IgA in 383 of 428. In the control group, 11 of 216 had increased levels of AGA-IgA, 5 of 216 of tTG-IgA, and 8 of 216 of EMA-IgA. In CD children younger than 18 months, elevated AGA-IgA occurred in 97% and elevated tTG-IgA and EMA-IgA were found in 83% of the cases. Conversely, in CD children older than 18 months, elevated AGA-IgA occurred in 94%, and elevated tTG-IgA and EMA-IgA were found in 99% of the cases.
CONCLUSIONS: In children older than 18 months, both tTG-IgA and EMA-IgA are sufficiently accurate to be used as a single antibody marker, whereas a large proportion of younger children with CD lack these antibodies. Therefore, when selecting children for small intestinal biopsy, the detection of a combination of AGA-IgA and tTG-IgA is optimal for identifying untreated CD in children younger than 18 months. |
http://glutendoctors.blogspot.com/
Dr. Petersen of HealthNow Medical explains the blood tests in her blog post titled "Interpreting Lab Work"
| Dr Vikki Petersen wrote: | The data below comes from our book, The Gluten Effect – available February 13, 2009.
Anti-tissue Transglutaminase Antibodies - Anti-tissue Transglutaminase Antibodies (tTG antibodies) are auto-antibodies directed against “self” tissue. After gliadin crosses the intestinal lining, a special enzyme called tissue transglutaminase binds to gliadin and takes off a portion of the protein. This portion is called glutamine. tTG antibodies are antibodies that are directed against the complex of gliadin attached to the tissue transglutaminase enzyme. tTG antibodies are 90 percent accurate in Celiac disease because they represent immune system attack at the level of the intestinal lining. Gluten sensitivity that involves minor intestinal injury or no villous atrophy will be less likely detected by tTG antibodies. Therefore, tTG antibodies correlate best with villous atrophy as several studies have supported, and a negative tTG antibody test (or EM antibody test for that matter) does not rule out gluten sensitivity when intestinal involvement is minimal or absent.
Anti-Endomysial Antibodies - Anti-Endomysial Antibodies (EM antibodies) are auto-antibodies. Gliadin is a gluten protein so therefore when the immune system attacks it, is not attacking “self” tissues but instead a foreign food protein. In contrast, as gliadin is absorbed through the intestinal lining, it attaches to the smooth muscle cells of the intestinal wall. EM antibodies are directed against proteins of these smooth muscle cells, and therefore EM antibodies are directed against “self” tissue. This defines them as auto-antibodies.Because EM antibodies attack the smooth muscle of the small intestine, these antibodies correlate better with damage to the intestine wall. Studies have supported an accuracy rate of approximately 90 percent for Celiac disease. Actually in one study, EM antibodies were present in 100 percent of individuals when total villous atrophy was present. However, EM antibodies are ineffective in detecting individuals with silent or subclinical gluten sensitivity. If minor involvement of the intestinal lining occurs or if no intestinal involvement is present, EM antibodies are much less accurate.As with Anti-Gliadin Antibodies, EM antibody testing should evaluate IgG and IgA forms of antibodies. If a gluten sensitive patient is IgA deficient, IgA EM antibodies may be falsely negative even for Celiac disease.
Anti-Gliadin Antibodies - Gliadin is the protein component of gluten that triggers the immune reactions in sensitive people, and therefore many people with gluten sensitivity have antibodies to this protein. Testing for anti-gliadin antibodies (AGA) is a simple blood test, but studies have shown that it is less sensitive for detecting Celiac disease compared to other antibodies. The confusion is that the ability of AGA to detect gluten intolerance has been defined in conjunction with a positive intestinal biopsy. While this may be a standard for Celiac disease, we now know that this is an inaccurate standard for gluten sensitivity. In fact, AGA may be the best current diagnostic test when considering all gluten related disorders. In testing for AGA, antibodies of both the IgG and IgA classes are checked since low total levels of IgA may be present. If a person has low total IgA levels, antibody tests for IgA may be falsely negative.
Total Serum IgA Level - Low total levels of IgA antibodies are rarely found in the normal population with one out of every six hundred people having this condition, but in gluten sensitivity, low IgA levels are more common. This reflects the increased IgA antibody production in the intestine to fight off gluten as it attempts to enter our bodies. If a low level of IgA is present, then certainly IgG varieties of the antibody tests described above will be more accurate in diagnosing gluten related conditions. In general, total IgA levels are not ordered often since IgG antibody tests are usually ordered concurrently. Therefore, defining a low IgA level adds little information in making a diagnosis. There is a general theory however that a lower IgA level suggests greater inflammation of the intestinal lining and greater chronicity of disease. A low IgA level may provide some insight into duration of disease.
A high serum IgA level as seen in the above test is likely indicating an infection. Increased serum IgA is common in skin, gut, respiratory and renal infections. We know this patient has DH so secondary skin infections do make sense. |
*The Antigliadin IgA and IgG tests have fallen out of favor due to the lack of specificity [other medical issues can be the cause of these antibodies]. However, some organizations and Doctors do feel these tests are of importance and still include them in their panel of tests. Gluten maybe an issue, and should be investigated a bit further. These tests ARE included in followup testing to determine dietary compliance, so there is value to them.
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa
Last edited by aklap on Tue Apr 07, 2009 8:57 pm; edited 50 times in total |
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robin1167
Joined: 12 Jan 2005
Posts: 8
Location: Wayne, pa
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| Posted: Mon Jan 17, 2005 6:09 pm Post subject: biopsy |
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Eactly what would the biopsy say?
Mine said: Duodenal surface intraepithelial lymphocytosis without other hitopathologic abnormalities is a non specific finding, but has been associated with celiac disease in - 10% of cases.
It also reccomened to have the serum celiac antibody studies done which I did and were negative. So now what? |
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maria1223
Guest
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| Posted: Mon Jan 17, 2005 10:05 pm Post subject: celiac |
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it is telling u that their is not enough to go on. but a gluten free diet will never hurt u so go for it .
stay well  |
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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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| Posted: Tue Jan 18, 2005 12:30 am Post subject: Re: biopsy |
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| robin1167 wrote: | Eactly what would the biopsy say?
Mine said: Duodenal surface intraepithelial lymphocytosis without other hitopathologic abnormalities is a non specific finding, but has been associated with celiac disease in - 10% of cases.
It also reccomened to have the serum celiac antibody studies done which I did and were negative. So now what? |
Hi Robin,
If I were in your shoes...I think I'd try a GF diet for awhile and see how I feel. I agree with Maria! You may need to stay on it for awhile to see how it goes. Heck - you've got nothing to loose by trying it....and everything to gain!!
Just for grins I did a google on intraepithelial lymphocytosis. Here is a study that talks about your situation. Have they investigated the possiblity of Crohn's? Have you been using NSAIDs lately? They talk about investigating Gluten Sensitivity. Which was done with your blood tests. Do you know what blood tests were run?
------------------------------------------------------------------
Am J Gastroenterol. 2003 Sep;98(9):2027-33. Related Articles, Links
Significance of intraepithelial lymphocytosis in small bowel biopsy samples with normal mucosal architecture.
Kakar S, Nehra V, Murray JA, Dayharsh GA, Burgart LJ.
Department of Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
OBJECTIVES: The aim of this study was to determine the specificity of increase in intraepithelial lymphocytes (IELs) with normal villous architecture in small bowel biopsy samples for diagnosis of gluten sensitivity (GS) and its significance in the absence of GS. METHODS: Small bowel biopsy samples from 43 patients with increased IELs and no other pathology were reviewed. Patients with prior diagnosis of GS were excluded. A group of 46 patients with normal duodenal biopsy during the same period served as controls. The clinical records of patients and controls were examined for presenting symptoms, laboratory tests, and final clinicopathological diagnosis. Immunohistochemical characterization of IELs was performed in 13 cases. RESULTS: Four (9.3%) patients had GS based on positive IgA antiendomysial antibodies (n = 3) and favorable response to gluten-free diet (n = 4). One patient (2.2%) had partially treated tropical sprue; six patients (14%) had disorders of immune regulation including Hashimoto's thyroiditis (n = 2) and one case each of Graves' disease, rheumatoid arthritis, psoriasis, and multiple sclerosis; and six patients (14%) were on nonsteroidal anti-inflammatory drugs (NSAIDs). In contrast, none of the control subjects had GS (p = 0.05), tropical sprue, or immunoregulatory disorders (p = 0.011), and one (2.2%) was on NSAIDs (p = 0.04). Increased IELs were also observed in Crohn's disease, lymphocytic/collagenous colitis, and bacterial overgrowth, but the association did not reach statistical significance. Histological features (number and distribution of IELs, crypt mitoses) and immunophenotypic analysis of IELs did not reliably distinguish GS-related from non-GS-related causes of increased IELs. CONCLUSIONS: Intraepithelial lymphocytosis in an otherwise normal small bowel biopsy is somewhat nonspecific, but in nearly 10% of cases can be the initial presentation of GS. Therefore all patients with this finding should be investigated for GS. Increased IELs may also be associated with autoimmune disorders and NSAIDs.
PMID: 14499783 [PubMed - indexed for MEDLINE]
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa |
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dalmatinka
Joined: 30 Jun 2005
Posts: 2
Location: Houston, TX
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| Posted: Wed Feb 21, 2007 4:26 pm Post subject: Re: Celiac Blood tests & more diagnostic info |
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I would like to get tested for Gluten intolerance but don't know where to start. I have no insurance and would like to order a test myself. Are you familiar with HealtCheckUSA. Would that be a good place to order a test or do you have another recommendation? You seem to be very educated, thank you so much.
| aklap wrote: | Doctors will usually start with a set of blood tests called a Celiac Panel that should consist of the tests below. If the panel does not include all tests, you may not get the entire picture.
Please request your doctor to run ALL of these tests. Not all Doctors will know about Celiac Disease (CD) and may be unfamiliar with proper testing. This is where educating yourself becomes important.
You must be consuming gluten in order for these tests to be as accurate as they can be. Do not go gluten free (GF) before these tests are done.
If the blood tests come back positive, they may want to scope you to check for intestinal damage (the gold standard for Celiac diagnosis).
A complete Celiac Blood Panel:
Antigliadin IgA and IgG*
May indicate Non Celiac Gluten Sensitivity
Anti-tissue Transglutaminase Antibody (tTG), IgA and/or anti-endomysial
An indicator of villi damage [slight damage is not always detected].
These tests are highly specific to CD.
However, autoimmune diseases can skew the results of these tests
Total serum IgA
Rules out IgA deficiency. This must be run to ensure proper IgA test results
Anti-reticulin IgA
Rarely used but, a very thorough doctor will include this
More on Diagnostic Testing can be found in the The Gluten File
Clan Thompson's Testing and their Results
Prometheus Labs CeliaPlus. Prometheus Labs is a respected and well known lab for processing Celiac Blood Panels.
Gluten Intolerance Group - Celiac Disease Diagnosis
American Celiac Disease Alliance - Diagnosis
*The Antigliadin IgA and IgG tests have fallen out of favor due to the lack of specificity [other medical issues can be the cause of these antibodies]. However, some organizations and Doctors do feel these tests are of importance and still include them in their panel of tests. Gluten maybe an issue, and should be investigated a bit further. These tests ARE included in followup testing to determine dietary compliance, so there is value to them. |
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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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dalmatinka
Joined: 30 Jun 2005
Posts: 2
Location: Houston, TX
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| Posted: Thu Feb 22, 2007 8:00 pm Post subject: |
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| Thank you so much. Which test would you recommend? |
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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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| Posted: Fri Feb 23, 2007 8:14 pm Post subject: |
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Despite the lack published proof - I'd do Enterolab because I know the history and the results of many people.
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa |
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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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| Posted: Tue Mar 13, 2007 5:33 pm Post subject: |
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bump
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa |
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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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| Posted: Sat Jul 21, 2007 9:41 am Post subject: |
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bump for Tonya
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa |
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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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| Posted: Sun Sep 02, 2007 7:22 am Post subject: |
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bump for wedge
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa |
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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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| Posted: Fri Oct 19, 2007 6:58 pm Post subject: |
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bump for Jed
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa |
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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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| Posted: Tue Jan 01, 2008 2:54 am Post subject: |
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bump
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa |
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HeatherL
Joined: 21 Feb 2008
Posts: 2
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| Posted: Thu Feb 21, 2008 11:55 pm Post subject: |
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How long is it recommended to be consuming gluten before getting the gluten celiac panel test done to get the most accurate result?
I did a self diagnosis and went gluten free for a few weeks. Now today after discussion with my new rheumatologist, (I am diagnosed with RA) and I told him how eliminating gluten has helped my condition and also digestive problems I have had on and off for years. He wants me to get the celiac panel test done, but after doing some research of my own, I have learned that you have to be currently consuming gluten for the test to be accurate.
So how long? I am willing to resume ingesting gluten, though i react to it and feel like crap but I really want to get to the root cause of many of my problems and I suppose I want an official answer. He has given me the lab order so I can go whenever i am ready.
Thanks for listening |
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aklap
Joined: 02 Oct 2004
Posts: 9880
Location: WI, USA
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| Posted: Wed May 21, 2008 1:30 pm Post subject: |
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Amoo, is this what you're looking for?
_________________
Al
“We cannot all do great things, but we can do small things with great love.” Mother Teresa |
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