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  • Jefferson Adams
    Jefferson Adams

    Can Celiac Disease be Diagnosed without Intestinal Biopsy?

    Reviewed and edited by a celiac disease expert.

    Caption: Image: Public Domain--Wikicommons

    Celiac.com 05/28/2013 - Is an intestinal biopsy always necessary to diagnose celiac disease, or can diagnosis be made without biopsy? To answer that question, a team of researchers recently set out to compare celiac disease–specific antibody tests to determine if they could replace jejunal biopsy in patients with a high pretest probability of celiac disease.

    Image: Public Domain--WikicommonsThe research team included Annemarie Bürgin-Wolff, Buser Mauro, and Hadziselimovic Faruk. They are variously affiliated with the Institute for Celiac Disease in Liestal, Switzerland, and Statistik Dr. M. Buser, Riehen, Switzerland.

    Their retrospective study included blood test data from 149 patients with celiac disease, along with 119 controls. All patients underwent intestinal biopsy, and all samples were analyzed for IgA and IgG antibodies against native gliadin (ngli) and deamidated gliadin peptides (dpgli), as well as for IgA antibodies against tissue transglutaminase and endomysium.

    They found that tests for dpgli were superior to ngli for IgG antibody determination: 68% vs. 92% specificity and 79% vs. 85% sensitivity for ngli and dpgli, respectively. Predictive values were also higher for dpgli than for ngli; positive (76% vs. 93%) and negative (72% vs. 83%).

    Regarding IgA gliadin antibody determination, sensitivity improved from 61% to 78% with dpgli, while specificity and positive predictive value remained at 97% (P less than 0.00001).

    A combination of four tests (IgA anti-dpgli, IgG anti-dpgli, IgA anti- tissue transglutaminase, and IgA anti-endomysium) yielded positive and negative predictive values of 99% and 100%, respectively and a likelihood ratio positive of 86 with a likelihood ratio negative of 0.00.

    Omitting the endomysium antibody determination still yielded positive and negative predictive values of 99% and 98%, respectively and a likelihood ratio positive of 87 with a likelihood ratio negative of 0.01.

    Conclusion: Antibody tests for dpgli yielded superior results compared with ngli. A combination of three or four antibody tests including IgA anti-tissue transglutaminase and/or IgA anti- endomysium enabled reliable diagnosis or exclusion of celiac disease without intestinal biopsy in 78 percent of patients.

    This two-step method of performing jejunal biopsy only in patients with discordant antibody results (22%) would catch all patients except those with no celiac-specific antibodies; who would then be caught through biopsy.

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    I was diagnosed two weeks ago through a blood test. My doctor explained that I needed a biopsy to have an "official" diagnosis, but he usually didn't order such an invasive procedure unless it was a severe case or unless the patient requested it (I certainly didn't want to deal with that, so I just took his word for it). In two weeks of a gluten-free diet, I'm sleeping better, I don't have abdominal discomfort, my nausea and vomiting is gone, I've lost a significant amount of weight, my thyroid problems have stabilized (for the moment; more bloodwork in a month to confirm) and I just FEEL better. The other day, my mother-in-law made a dessert which she assured me was gluten free. It wasn't (who doesn't know that flour is made from wheat???), and I had horrendous stomach pain for two hours after eating it. I don't need a biopsy to confirm what I already know. I know everyone is different, but in my case, the blood test was more than enough.

    I have heard that there are tax deductions for people DIAGNOSED with celiac. I am sure a biopsy is not worth the while to get them, however, i would make it very clear to your doctor, how you feel after a gluten-free diet and express that it should be noted in your chart. I believe the actual problem lies between diagnosing celiac or gluten intolerance, which is probably the reason for a biopsy.

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    I have heard that there are tax deductions for people DIAGNOSED with celiac. I am sure a biopsy is not worth the while to get them, however, i would make it very clear to your doctor, how you feel after a gluten-free diet and express that it should be noted in your chart. I believe the actual problem lies between diagnosing celiac or gluten intolerance, which is probably the reason for a biopsy.

    Can you expand on what these tax deductions are? How does that work, can you deduct gluten free food as medical expenses or pay them from a health account?

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    I could not understand one word in this article; therefore I learned nothing that would be helpful. The article was too technical and not written for the average gluten-free person trying to learn more about the disease.

    I agree. I think it would be helpful if the article was in English and not medical-alphabet soup.

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    I recently had a negative blood test for celiac and when I had an EGD they took only one biopsy in the small intestine, which came back negative. I am now attempting a gluten free diet and feeling better to a degree. The problems I was having included 20 pound weight loss in 2 months, being extremely shaky, exhausted, dizzy, moody after eating and unable to think clearly. My mom wants me to request a CT scan and not wait on the gluten few diet. I was wondering if anyone had any input on my symptoms from their own experiences?

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    My wife was diagnosed with celiac disease after stomach biopsy and blood tests were all negative.

     

    She was diagnosed with celiac disease from a capsule endoscopy. Stomach and duodenal biopsies are the tip of the 9 feet of jejunum and often miss celiac disease...

    Hi Matt,

    Where do you find the data that stomach and duodenal biopsies often miss celiac disease? Appreciate your help!

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    Guest Dylan Cornelius

    Posted

    Do patients undergoing the tests have to be eating gluten to test positive?

    When my gastroenterologist ordered my test, he told me since I hadn't been eating gluten recently, it would likely be a negative result. I ate bread every day for 30 days prior to my test as he directed, though he also said this probably wouldn't be sufficient exposure to yield a positive test result. I grew increasingly more tired and had greater digestive distress as those 30 days passed. My sleep increased from 8 hours nightly to 14 by the end. The test result was negative. Your mileage may vary.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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