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Ten Facts About Celiac Disease Genetic Testing

Celiac.com 04/24/2008 - Genetic tests for celiac disease and gluten sensitivity are readily available. Testing can be performed on either blood and mouth swab samples. If the testing is performed by certain laboratories not only will you have quite an accurate prediction of your risk of Celiac disease but also you may have information about the statistical probability that your children will inherit the risk, your likelihood of more severe Celiac disease, whether one or both of your parents had the risk gene, and for some laboratories you may determine your risk of gluten sensitivity without Celiac disease.

The absence of any portion of the high-risk genetic patterns DQ2 and DQ8 nearly excludes the possibility of celiac disease with an approximate accuracy of 99.9%. However, there is a big caveat about relying on "negative celiac genetic testing". To definitively declare you have negative celiac genetic tests requires that the laboratory test for and report the presence or absence of the entire HLA DQ genetic pattern, including both alpha and beta subunits. The DQ genetic patterns DQ2 and DQ8 have two subunits but some laboratories only test for the beta subunit. This DQ typing is complicated and difficult to understand even by physicians and scientists. I have written an updated detailed review that appears in the Spring 2008 issue of Scott-Free newsletter published by celiac.com.

Data collected by Dr. Ken Fine of Enterolab has supported the well-known fact that the absence of DQ2 and DQ8 does not exclude the risk of being gluten intolerance or sensitive though it now generally believed that one or both of those genetic white blood cell patterns are required to develop the autoimmune disorder known as Celiac disease or Celiac Sprue. However, there is a new study that reports that being negative for DQ2 and DQ8 does not completely exclude the possibility of celiac disease, especially in men. Previous studies have well documented blood test negative Celiac Sprue, also more common in elderly men with long-standing severe disease. Since DQ2 or DQ8 is almost universally present with the specific blood tests tissue transglutaminase and anti-endomysial antibodies are present it is not surprising that individuals without DQ2 or DQ8 that are negative for these two blood tests are being reported that meet criteria for Celiac disease.

These new studies are also providing further information that the genetics of Celiac is gender specific. If you are a man, your risk of celiac disease may be higher than a woman if you don't have the classic genetic patterns. Again, in this situation your blood tests may be negative. If you are a woman, the risk for Celiac disease is generally higher than a man, especially if you have received the at risk gene from your father instead of your mother.

Celiac is arguably the most common autoimmune disease. It is very common. It is easily treated. It affects 1/100 people worldwide. However, most people with celiac disease (~90%) are unaware, undiagnosed or misdiagnosed. Most adults finally diagnosed with celiac disease have suffered at least 10-11 years and have seen more than 3 or more doctors. Genetic testing is not only available but can be extremely helpful in determining your risk of developing Celiac disease, how severe it may be and the risk of your family members. Don't be one of those whose diagnosis is missed or needlessly delayed for over a decade. Get tested! Learn about the genetic tests for Celiac disease and if necessary educate your doctor about this testing.

Here are ten facts you should know and remember about Celiac genetic testing.

  1. Genetic testing can help determine your risk as well as your children's risk.
  2. Celiac genetic tests can be done on blood or a mouth swab sample but your doctor may be unaware of the tests, not know how to order them, or know how to interpret the results.
  3. Genetic testing is not affected by diet. You can be eating gluten or on a gluten free diet. Blood tests for celiac disease antibodies, however, need to be done while eating gluten. They can become negative within a few weeks of restricting gluten so if you are going to get the diagnostic antibody blood tests don't begin a gluten free or restricted diet before being tested.
  4. Some insurance companies do not for the Celiac genetic test and almost all who do require pre-authorization first. The following diagnostic codes are helpful when requesting insurance coverage: 579.0 (Celiac disease); V18.59 (family history of GI disease); and/or V84.89 (genetic susceptibility to disease).
  5. Some laboratories do not perform the all of the necessary components of the test to completely exclude the possible genetic risk of Celiac disease and most don't test for or report the other gluten sensitive DQ patterns. Before you accept that have a negative test you need to know if your test included both the alpha and beta subunits of HLA DQ or did they just perform the beta typing.
  6. In some rare individuals, especially some men, a negative genetic test may not exclude the possibility of celiac disease anymore than a negative blood test. Men more commonly have negative genetic tests and blood tests, especially older men with long-standing severe disease.
  7. Both the DQ type, and number of copies you have, matter when determining not only your risk but also the possible severity of celiac disease. Two copies of DQ2 carries more risk than one copy of DQ8 or only partial DQ2. Even a single copy of DQ2 alpha subunit ("half DQ2 positive") carries risk for celiac disease but most of the commonly used laboratories for Celiac genetics do not test for or report the presence of this component of the celiac genes.
  8. The absence of at risk genes DQ2 and/or DQ8 does not exclude the possibility of being gluten intolerant or sensitive. You may respond to a gluten free diet even if you don't have DQ2 or DQ8 or true autoimmune Celiac disease.
  9. You can get genetic testing without a doctor's order and the tests can be done without having blood drawn or insurance authorization if you are willing to pay between $150-400 (www.kimballgenetics.com and www.enterolab.com).
  10. Laboratories in the U.S. that are known to offer complete alpha and beta subunit genetic testing include Kimball Genetics, Prometheus, and LabCorp. Bonfils, Quest and Enterolab only test for the beta subunit portions and therefore their test can miss part of a minor alpha subunit that carries a risk of Celiac disease. A negative DQ2 and DQ8 report from these labs may not necessarily be truly negative for the risk of Celiac disease.
References and Resources:
  • HLA-DQ and Susceptibility to Celiac Disease: Evidence for Gender Differences and Parent-of-Origin Effects. Megiorni F et al. Am Journal Gastroenterol. 2008;103:997-1003.
  • Celiac Genetics. Dr. Scot Lewey. Scott-Free, Spring 2008.

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37 Responses:

 
Ann Stewart

said this on
01 May 2008 3:43:31 AM PST
Great info .........I never knew... always thought you had to have the intrusive biopsy test.

 
Frances l Garcia,MD
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said this on
01 May 2008 6:19:21 AM PST
Excellent: it explains why I am a severe celiac and yet am negative for the antibodies. I am a woman, northern European, Hispanic and Middle Eastern ethnicity and no previous known family history. My sons have tested negative for tTg and . My brother is negative for the tTg and antiendomyasial antibodies but has severe osteoporosis at 45 years of age, without any known risk factors. We need to do genetic testing!!

 
Carina
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said this on
01 May 2008 7:24:51 AM PST
Thank you. I need to get my kids tested, and I feel better knowing these things before I go in.

 
Carri
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said this on
01 May 2008 7:39:01 AM PST
Wow, very comprehensive yet easy to understand the 'genetics lingo.'

 
sharon mackey
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said this on
01 May 2008 11:57:36 AM PST
I had seven endoscopies done only 2 of them with same doctor---rest all different--celiac came back negative--also blood test---I finally found a celiac doctor whom my daughter recommended--she also has celiac disease--she did a cheek swap and sure enough I have celiac disease and have had it for a few years. I started having stomach problems and had a hernia and a sphincter that didn't close--so this was the problem with my severe bile reflux and gerd. I developed scurvy a year before that and it took 3 months for doctors and a specialist to try and find out what it was. I had it very badly on my whole right leg. Discolored-blood collections under the skin---the hundreds of red dots-due to very low platelets- All of the symptoms I had visible and not and no one put it together. I kept suggesting it was a problem with malnutrition but no one listened. My stomach and throat were raw. Had all kinds of tests done---finally my oncologist told me to have a leg biopsy done and sure enough it came back as scurvy. A lot of damage was done to my digestive system. Also had my gallbladder removed-had a small stone--they thought this might have been the source of the reflux --I ended up with worse reflux. It took me 2 years to find a surgeon to do the fundoplication--I am a high risk patient--allergic to many, many,drugs---pump prohibitors gave me seizures-so I am unable to take anything for the gerd. thought all would end there--I still have reflux severely---weigh 93 pounds with many food allergies--casein, yeast all dairy and it goes on----no rice-my blood counts and platelets are always bad--high calcium--cysts now found on my thyroid and most probe my parathyroid glands--didn't show any if the x-rays but I have all the symtoms-kidney stone--I only have one kidney--donated the other to my sister in 1968. I live in pain every day--trying to cope---your articles help me a lot. Thank you.

 
European lady

said this on
01 May 2008 2:23:35 PM PST
I am a Northern European lady and have family history of gluten sensitivity, I am gluten sensitive but do not have DQ2 OR DQ8 AND had one doctor at Mayo clinic telling me that it is 100% certain that I can't have Celiac disease.
A gluten-free diet put my intestinal symptoms on the right track.

 
Mimi
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said this on
01 May 2008 5:07:55 PM PST
Thank you for a novice friendly explanation of the genetic testing for celiac disease. I did not know about the alpha and beta-I only had one done.

 
Linda Hays
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said this on
01 May 2008 7:54:58 PM PST
It was very good and informative.

 
Jean
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said this on
02 May 2008 9:15:07 AM PST
Thank you for this article. It confirms suspicions that I had about family members in my family who probably have the disease and refuse to consider it. All members that I'm referring to have diabetes.

 
Joan
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said this on
11 Apr 2010 3:28:39 PM PST
I believe that my mother, who died of diabetes, probably had celiac disease. No one that I know of in my family had it, but then, where did I get it?? My daughter tested negative but we know she has it. She is OK as long as she avoids gluten.

 
LENA
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said this on
02 May 2008 3:17:07 PM PST
I have a few concerns, I had a biopsy done in 10/08 and it tested negative for celiac disorder. However 7 months later I'm still having the same symptoms and now my doctor is saying that's not a guarantee (the biopsy) and there treating me as if I do have celiac now.

 
julie
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said this on
04 May 2008 3:13:32 AM PST
Could you please provide some theories as to why older men who test negative for the celiac risk gene can actually have celiac.

 
disillusioned
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said this on
11 May 2008 2:06:49 PM PST
Thanks a lot. I was going to go with Enterolab until I read this article. Now I plan on testing with Kimball or Labcorp. However, I couldn't find any info on Kimball or Labcorp's websites which mentions alpha and beta subunit genetic testing. Are you sure they still offer this? Has anyone else here gotten these tests done?

 
Tara
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said this on
13 May 2008 10:44:55 AM PST
I just ordered the tests from Kimball (after seeing the special they're offering right now through this website) and am eagerly looking forward to getting the test and hearing the results. My 2 sisters and I all are showing signs of gluten sensitivity, but none of us has been officially diagnosed yet.

 
Richard
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said this on
14 Jun 2008 10:49:36 AM PST
Very informative, as a scientist and a celiac I am amazed how complex the genetic marking of celiac disease is. I would even dare to say that it would be easier to look for a gluten-tolerant marker and use the non-presence of this marker as an indicator of gluten related conditions! However, I am even more amazed at the very un-scientific diagnosis process that many 'doctors' follow. Too many people are reporting multiple misdiagnoses and inaccurate testing regimes. As a researcher (astrochemist) I would not trust these 'doctors' in my lab!

 
Monique
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said this on
09 Apr 2009 5:57:30 PM PST
I'm Celiac (finally correctly diagnosed in 2001) and have a son (he's 15) that has tested positive for Celiac on one of the blood test. He's had 2 blood tests. The doctor didn't want to do a biopsy so I opted to do genetic testing. I chose Prometheus to do it. It cost $509 and the test came back 'inconclusive' for Celiac. Does anyone know what that means? My doctor said that means that my son may get Celiac and he may not. I'm not thrilled that I spent $509 to find that out. I already knew that!

 
Barbara
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said this on
25 May 2009 7:52:25 AM PST
Thank you for this article. I was recently diagnosed with celiac and could not figure out how I was going to get my kids tested (11 & 8 years) without a biopsy, especially as neither of them seem to have any real problems. This is a much better way of checking. My doctor uses Quest so will have to discuss either using one of the others or doing it myself. Thanks again!

 
Adi
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said this on
03 Jun 2009 8:48:12 AM PST
Thank you for this very informative article.
I am a self diagnosed Coeliac…
I had all the “classic” symptoms but was misdiagnosed by all the doctors that I’ve seen over a 13 year period!
I have a sister that was properly diagnosed as Coeliac at 9 months old. At 15 years old, I had severe Anemia that didn’t respond to any treatment, Fatigue, Nausea, terrible abdominal pains, weight gain etc but the doctors convinced me (and not my mum…) that I didn’t have Coeliac based on a negative blood test and endoscopy.
Finally, at 28, when the stomach pain attacks grew too close together I insisted on another blood test- which came out positive
On the advice of my GP, I skipped the biopsy and started a gluten-free diet straight away. I had immediate positive affect on my overall health
Since then, my 2 kids have been genetically tested. As they carry 1 gene only, the official result was “Coeliac disease cannot be ruled out”
I chose to put them on a strict gluten-free diet, based on my experience. I just had a 3rd child and not even going to bother testing this time….
My concern is regarding the effect of the 13 year long exposure to Gluten on the risk of bowl cancer
If anyone could point me to some information regarding that I would appreciate it

 
Melinda Landon
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said this on
12 Jan 2011 5:03:16 PM PST
Hi, celiac myself and wanting to make a difference in the world by helping others. I would like to know if you are interested in sharing your story. You say touch the life of another going threw the same thing. I am writing a book of people wrongly diagnosed. Could you help me please. I would love to share your story.

 
arnold zimmerman
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said this on
26 Apr 2012 6:15:38 AM PST
Celiac is still under the radar no matter how much we hear about it. The Gluten Free Diet and these diets are no better than the SAD in full bloom. Allopathic doctors are true dinosaurs in this field and I do not think the brainwashing they received in med school and paid for, will be easily undone. Many people by choice do not eat grains, even without celiac and I think that is a good idea. When a "gluten free" recipe by a celebrity celiac sufferer begins with rice flour, sorghum flour, white sugar, margarine and canned icing, run like hell!

 
Lynn
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said this on
28 Aug 2009 9:54:19 AM PST
I'm so glad I read this article before choosing a lab. Turns out I have an alpha sub-unit that would not have been detected by labs only checking for the beta sub-unit.

 
Shirley & Bob
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said this on
11 Sep 2009 6:37:38 AM PST
Very interesting. I had a blood test yesterday and will wait for results

 
Jeff Kelly
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said this on
03 Mar 2010 12:04:11 PM PST
What I STRENUOUSLY object to in this article is the usage of the term "True Celiac Sprue." This is scientifically and practically a TOTAL MISNOMER. It persists in medicine because medical doctors have ZERO to fifteen minutes of training in Celiac Disease, and the so-called intellects in the field make this extremely artificial, unnnecessary, and wholly disparaging(to add to the already extant built-in disparagement in Celiac inherently)distinction in language that bears ZERO relation to REALITY. They do so in the name of science but cannot in fact justify their actions with sound comprehensive science, just as Lewey accurately acknowledges it is not possible to exclude a possible diagnosis of Celiac on the basis of negative genetic or blood antibody tests(or even BOTH those situations).
On the positive side I do feel the article makes an important contribution to the gender designation generally supportive of the understanding that men have a harder time obtaining an affirmative diagnosis and some of the reasons for that--although one of the main reasons has nothing to do with medicine and everything to do with Sociollogic and even Socioeconomic factors in that society generally does not easily accept the notion that men should be designated easily as disabled or of a similarly suggestive adjective with regard to health issues, lest the very traditional basis of our society thus be undermined in its basic underpinnings---and this bias is clearly reflected in clinical medicine with relation to Celiac disease. The preference is always, in "acknowledging anything"--to rather conclude some kind of mental health problem, which serves numerous purposes, not the least of which is to minimize the medical aspects lest medical doctors have to accept as much responsibility for caring for such patients as Dr. Lewey has graciously dared to do in his professional life here. The doctors I saw with my disease were in Northern Colorado and over a span of four years' time during the middle 1980's--I did not get done to "The Springs" until I went there to see a woman Naturopath named Shields, who while evidently quite learned generally, also held out zero practical help with my experience of severe Celiac Sprue that took me down to a weight of 119 pounds at age 30 standing six feet two inches in height.
So I feel I have reason to remain upset over the ignorance of the past, and indeed, while ignorance is not confined to relatively rural areas of the country like Colorado, I certainly encountered a whole bunch in that state vis-a-vis this Celiac thing. And so I commend Dr. Lewey for his "new breed" attitude, a refreshing and necessary element in improving the quality of care of that percentage of us in society he may in fact encounter in his practice.

 
John Wilson
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said this on
08 Mar 2010 8:39:41 AM PST
I actually just got my testing done, and they tested for and provide results for the beta and alpha subunits.Thank you for all of the information though, it was great.

 
Shantu
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said this on
08 Feb 2012 9:55:33 PM PST
Thanks for sharing this...my blood test came negative so I want to get tested with gene testing. Can you tell where did you get tested and how much it cost. And if you want to tell me what was your result. Please reply because I'm suffering with this problem.

 
Miško
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said this on
30 Mar 2010 11:01:05 AM PST
On the verge of desperation, after a lifetime of misery (I am 52) and a feces sample on helicobacter pylori which tested negative. I have a very pronounced suspicion for celiac disease. This even before I have discussed this with my physician, which I certainly shall. Thanks, Adi and Sharon Mackey, your contributions are valuable for me.

 
Paula
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said this on
08 Dec 2010 7:20:48 PM PST
My 3 yr old just had the genetic tests done - and those results, according to the doctor, not only diagnosed my son but helped treat my daughter (7 yrs old)
My daughter (7) was finally diagnosed with Celiac earlier this spring, after years of tummy issues dating back before she could walk. Her case is so severe, that 10 months on the strict diet haven't cleared up her diarrhea or tummy cramps.
My son (3) has been "failure to thrive" since before he could walk, but tested negative against Celiac this spring.
He finally started gaining weight when we began our gluten-free quest for my daughter. After 10 months of the gluten-free diet for him, he's finally at the 50% for his age/weight/stature.... I didn't think I'd ever see that number again.
Our doctor ran the genetic test on my son & his results were the double DQ2 - the highest risk factor for Celiac, associated with the most severe symptoms.
He firmly declared my son officially "Celaic" based on history of failure to thrive & then growing exponentially on the diet, paired with his genetic results.
He also said this genetic pairing of double DQ2 is dominant, and is certain my daughter is the same way. We are bypassing several passive tests on her, and going straight for immunosuppressive therapy. We finally have a confident doctor, and finally have answers.

 
andrea
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said this on
15 Jan 2011 9:02:05 PM PST
Paula, wow, glad to her you have found a great doctor and answers you need!!! my daughter started vomiting and diarrhea Dec 12 2010.. there was no obvious reason as to why.. at first we thought she ate too much cotton candy. after it was all out of her system, she seemed to do a little better... then a week later vomiting again! no apparent reason. Dr said it was some sort of tummy virus and it could take up to a month to clear. Funny part was no one else in the house "caught" this virus. Another ok week passed and boom vomit again..poor baby seemed to have tummy aches prior to getting sick (cramping, chills, crying, and saying ouch)..
again another week went buy. the only pattern was she would get sick once a week like clock work (no matter how normal she was feeling earlier). finally took her in to be seem yet again and the Dr mentioned celiac disase as a long shot (but still mentioned it) i have since noticed how certain foods trigger a tummy ache and even gas.... her stools were normal for a full week (finally) but threw up after crying a lot. Not sure if the vomiting was caused by crying or something more ... another "normal" week went by and just this Friday 1/14 2011 she vomited a ton..... she was in the middle of crying, she gagged and then a few moments later it all just came out! again not 100% sure what was the exact cause... i am super bummed about this. poor kid has been having issues for a few months now and I don't want to continue to give her things that will keep her sick. Her pediatrician has asked me to log all the foods I give her...Ii am just considering asking for her to be tested and stop with the guessing game. I'm over her feeling bad and having what seems to be tummy aches. I am scared of getting negative results but my daughter actually having celiac. I need to make sure i test correctly. Paula, i am wondering what city you live in and the Dr you see for your children? i live in FL and i just wanna go straight into trusted Dr.'s

 
Kim
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said this on
19 Oct 2011 6:36:51 PM PST
I am pondering whether or not to get all the testing. I went gluten free for 2 months and my symptoms were gone, went back on gluten to get tested and the symptoms were worse than before. So I cancelled my endoscopy because I knew I would need to be gluten free regardless of if it is celiac. So my question is, how important is it to be tested? Is it a matter of knowing how strictly gluten free I need to be i.e. cross contamination issues? My daughter has been diagnosed with gastroparesis but got a neg biopsy for gluten but I think it was a false neg. She always had gastro issues especially with whole grains.

 
jgreer
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said this on
26 Nov 2011 10:15:08 AM PST
Not sure where you live, however if you are Canadian and are diagnosed with celiac disease as a result of a biopsy then you can use your food receipts for gluten free products against your income taxes. You must have the biopsy to do this though!

 
Karol
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said this on
18 Mar 2012 8:10:45 PM PST
When Prometheus does the testing, and reports "HLA-DQ2 and other low-risk allele" does anyone know what they usually find as the other low-risk gene unit? I know I have HLA DQ2.2, but would like to find out the part they did not tell.

 
Christine
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said this on
11 Apr 2012 11:49:20 AM PST
I wish I had seen this article previously. Last summer I paid Enterolab for genetic testing and received what I consider to be an ambiguous reply where I was identified as having 2 gluten intolerant beta genes HLA-DQB1 0202 and 0301, my Iga was elevated and I had an autoimmune reaction. Since I was told I did not have the main celiac genes I assumed I was in the clear not knowing that there was still a risk. I thought either you had it or you didn't. When I later inquired about the results after noticing the word "main" I was told that an individual with the two beta genes I carry has less than a 1% chance of developing Celiac. They never offered any info about alpha testing or genes. Several months later I found out about the alpha gene component and now have to pay a different lab to gain the rest of the picture since I am still not feeling well and have a whole host of symptoms. I did try to write to Enterolab again for answers, but this time they did not respond at all. Still waiting for the results from the second lab, however, I finally feel like I might have some closure. It's been a bit of a roller coaster. Initially, after months of feeling poorly I saw a homeopath, who told me I had a wheat intolerance, among others, and to try a gluten free diet. I had never heard of celiac and she never told me of the concern. I have been gluten free for 2 years. But haven't been completely strict with it thinking it was only a sensitivity. So, a secondary problem are professionals advising to go on a gluten free diet without also educating about celiac first.

 
Donna
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said this on
09 Dec 2012 6:42:00 PM PST
Whether you have celiac disease or just gluten sensitivity, it is my understanding that ingesting gluten causes intestinal damage. If you have a negative reaction to eating gluten, why bother getting tested? Especially since you can be gluten sensitive without testing positive on any test. I don't believe that there's a cure for celiac disease or gluten sensitivity, just a treatment; avoid ingesting gluten and your problem is solved!

 
Eileen
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said this on
28 Feb 2013 10:51:15 PM PST
While it's helpful to know the diagnostic (ICD-9) codes that will cover the genetic testing with your insurance, your doctor may only use those codes if you either already have the disease, or a family member has the disease, or if you are "predisposed" to the disease. You cannot say that you have the disease in order to test for the disease. That would be fraudulent, and now your insurance company thinks you have the disease. This goes into your medical record, and the next time you want to apply for life insurance, you will likely be turned down. So, consider that before you allow your doctor to use celiac disease as your diagnosis code. I'm certain Dr. Lewey would agree with that.

 
beatrice
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said this on
21 Mar 2013 7:19:29 PM PST
Genes don't mean you HAVE anything, only that you could, if the environment is right, develop whatever it is. Also, you don't need a biopsy for celiac disease if you have positive blood tests. It has been shown fairly accurately that the blood tests reflect the biopsy findings. The only people who need biopsy are those with 'possible' positive blood tests. Never the negative, nor the strongly positive. This is recent studies looking at patients who have had biopsies. You just need the right blood tests.

 
Jeff
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said this on
06 Nov 2015 11:07:51 AM PST
None of this happens to be correct, Beatrice. Sorry to burst your bubble but number one, most are not sent for intestinal biopsy due to under-suspicion as a general rule among physicians for celiac. Intestinal biopsy does, by and large, detect most celiac disease when performed. The blood tests are rife with problems of false negatives and therefore despite pronouncements by well-meaning yet totally uninformed physicians, reliance upon these is not justified. Genetic tests can show the proclivity and likelihood of celiac and thus, a positive gene test for either DQ2 or DQ8 is most certainly more helpful and also less invasive than any other single form of testing. Many of us prefer to feel that what we do, ie, lifestyle and environment and such is more important than our genes and yet, science is telling a totally different story with respect to celiac sprue.

 
Jean
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said this on
07 Nov 2015 3:06:35 PM PST
I am using a 'beta only' lab to save money. I've done a lot of research and have found that you can determine most of the alpha units by looking at a chart that tells you which beta and alpha units usually link together. I use the one at the Wikipedia HLA DQ page.
The only problem I've found with this method is with a DQ2,7 combination. It is important to know if the 7 is a 7.5 or not. If it is, it will combine with the 2 to make a 2.5 trans, which is very high risk. If not, there is still some risk with the DQ2, but much lower. If you do have this combination and you have celiac symptoms, it's probably safe to assume it is 7.5.




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