Celiac Disease Diagnosis, Testing & Treatment (Gluten-Free Diet)

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Is an intestinal biopsy always necessary to diagnose celiac disease, or can diagnosis be made without biopsy? 

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A recent study of celiac screening methods shows that testing for antireticulin antibodies (ARA) in patients with celiac disease is obsolete. 

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Currently, there are two main diagnostic tools available to would-be celiacs: biopsy and serological (antibody) tests. For the past few decades, biopsy has been the only relatively reliable (and diagnostically accepted) path to diagnosis. The problem is, biopsies are expensive and highly invasive – antibody tests would be a cheap and painless alternative, but they haven't proven themselves to be accurate enough for conclusive diagnosis.

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I speak to many people from across the country and internationally who contact me requesting help. The issues they face could be summarized into three categories: 1. individuals with celiac disease who do not have their disease under good control; 2. those with gluten sensitivity whom remain less than healthy despite their gluten-free diet...

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Doctors can face challenges when attempting to diagnose celiac disease in patients who have already begun a gluten-free diet, and/or when the results of tests are inconsistent. To better understand this problem, a group of researchers set out to assess the benefits of an in vitro gliadin challenge.

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Research has indicated that giving small amounts of wheat-rich food to people with celiac disease, who are on a gluten-free diet, will trigger interferon (IFN)-γ-secreting T cells in the bloodstream. These T cells react to gluten, and can be easily detected.

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A diagnosis of Celiac disease is measured mainly by an adverse response to gluten, yet there is very little in the way of data regarding gluten challenge in adults on a gluten-free diet. A research team recently studied the kinetics of histological, serological, and symptomatic responses to gluten challenge in adults with celiac disease.

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A pioneering new testing system promises quick, accurate, cost-effective diagnosis and monitoring of celiac disease. The pioneering new test was developed with EU-funding, and should be available in hospitals and clinics across Europe and elsewhere within a few years.

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Diagnosing celiac disease can be challenging for doctors if a patient has already started a gluten-free diet, and/or when test results are inconsistent. A research team set out to evaluate the in vitro gliadin challenge in such patients.

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A trio of researchers recently compared duodenal and jejunal small intestinal biopsies for diagnosis and follow-up of celiac disease. The researchers included J.W. Meijer, P.J. Wahab, and C.J. Mulder from the Department of Pathology, Rijnstate Hospital Arnhem, The Netherlands.

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anti-tTg levels at least 5x the upper limit of normal are sufficient to diagnose celiac even in adults; a biopsy is unnecessary.

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A company called Microtest Laboratories is manufacturing doses of what they claim may be the first effective vaccine treatment for celiac disease. At this point, the only treatment for celiac disease is to avoid gluten in the diet.

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Detecting gluten sensitivity early in individuals can have major health benefits, preventing not only the development of celiac disease (that is, villous atrophy, according to Dr. Fine), but a wide array of autoimmune diseases and conditions such as osteoporosis, malnutrition, infertility, certain mental disorders, and even some forms of cancer.

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In an effort to understand how delayed celiac disease diagnosis became the norm for most patients over the last few decades, a research team conducted a study to assess the issue. Their study also looked at how delayed diagnosis affects health-related quality of life (HRQoL) for those with celiac disease, and considered differences with respect to sex and age.

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A research team recently assessed variability in small bowel histopathology reporting between different pathology practice settings, and its impact celiac disease diagnosis.

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Non-controlled studies suggest that Rifaximin may improve celiac disease symptoms in such cases. However, up to now, no controlled trials have been conducted.

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Villous atrophy may be present only in the duodenal bulb, so a biopsy of this region should always be including when diagnosing celiac disease.

A team of researchers set out to assess the clinical, pathological and serological spectrum of celiac disease in a general population via prospective study (Kalixanda study).

Adherence to biopsy guidelines recommended by the AGA in 2006 - that at least four samples be submitted - doubles the probability of a celiac diagnosis.

New research on using HLA-DQ2-gliadin tetramer test to detect celiac disease.

In an effort to improve diagnosis of celiac disease in patients already on a gluten-free diet, a team of researchers recently evaluated HLA-DQ2-gliadin tetramers for detection of gluten-specific T cells in peripheral blood and histological changes in the duodenum after a short gluten challenge as a diagnostic tool.