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  • Jefferson Adams
    Jefferson Adams

    Do We Really Need Biopsies to Diagnose Celiac Disease?

    Reviewed and edited by a celiac disease expert.

      Can celiac disease be accurately detected without a biopsy?

    Caption: Can blood tests alone accurately diagnose celiac disease? Photo: CC--Garland Cannon

    Celiac.com 07/13/2017 - Until recently, duodenal biopsy was considered the gold standard for diagnosing celiac disease, but that is changing.

    A number of studies have shown that celiac disease can be diagnosed using serological tests alone, but many clinicians have yet to embrace this approach.

    In both retrospective and prospective studies, one research team showed that certain IgA-tissue transglutaminase antibodies levels can predict celiac disease in adults 100% of the time.

    After making some adjustments to the analytical method for measuring the antibody, a team of researchers recently set out to to determine whether such serum tests can reliably diagnose celiac disease in large numbers adult patients without the need for small bowel biopsy.

    The research team included GKT Holmes, JM Forsyth, S Knowles, H Seddon, PG Hill, and AS Austin.

    They are variously associated with the Royal Derby Hospital, the Department of Pathology, and the Derby Digestive Diseases Centre at the Royal Derby Hospital in Derby, UK.

    For their study, the team conducted a retrospective analysis in an unselected series of 270 adult patients who underwent small bowel biopsies and the measurement of serum IgA-tissue transglutaminase antibody levels from 2009 to 2014.

    At an IgA-tissue transglutaminase antibody cut-off greater than 45 U/ml (>8×upper limit of normal+2SDs) the positive predictive value for celiac disease in this cohort was 100%; 40% of cases were above this cut-off.

    The team found that they could use IgA-tissue transglutaminase antibody levels to reliably diagnose celiac disease in a high proportion of these adult patients.

    This study adds to the growing body of evidence that supports the diagnosis of celiac disease without a mandatory small bowel biopsy.

    As a realist of these findings, the study team has changed the diagnostic guidelines for their center, and will now make celiac diagnosis based on cut-off levels of IgA-tissue transglutaminase.

    This is exciting news. For many, many years, the biopsy was considered the gold standard for diagnosing celiac disease.

    By eliminating biopsies in favor of IgA-tissue transglutaminase levels, diagnosing celiac disease could become much easier and even cheaper.

    Do you have celiac disease? Did you receive a biopsy for diagnosis? How do you feel about celiac diagnosis without biopsy? Share your thoughts below.


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    12 years ago I had low bone density. Endocrinologist did one test. tTg. Normal was 1-19 mine was 181. Proved part of why my bone density was not good at age 50. I tried to eat well but gluten was in tiny amounts in many places. I didn't know I was celiac, but never ate sandwich or pizza instinctively. I refused the "gold standard" biopsy. I don't see a need for invasive tests when I can change behavior. I am gluten-free. I don't eat gluten-free junk either. I am much better. Still work as I was undiagnosed for so long and am allergic to other things due to leaky gut. I am healthier than most. Wonder if the 25% earlier death is for celiacs that comply. Thanks for your article. I sensed I was wise but people often ask about biopsy. I am now 62.

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    I was diagnosed on blood tests alone at age 51, 6 years ago. All of my markers were off the charts high. I had been having unusual blood work for years - high platelets, elevated liver enzymes, thyroid issues, etc. The blood work was so definitive, even after 2 weeks of no gluten, that by the time I saw the gastroenterologist a month later, he did not want to reintroduce gluten and made the diagnosis on blood work - I had the full celiac panel, all markers were high.

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    I was just diagnosed with celiac with the blood test - my numbers were extremely high and the doctor gave me the option to do the biopsy. He said with as high as my numbers were it wasn't really necessary if I didn't want it. I have chosen not to get the biopsy done. rnrn

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    I am surprised to hear two people in the comments say they were "diagnosed" using a genetic test. Genetic tests for celiac disease can, in some cases, exclude a diagnosis of celiac disease, but they cannot diagnose it. One third of the population have the genetic markers for celiac disease. Only a small percentage of those will develop celiac disease. Genetic testing must be followed up by other tests. I am concerned that people are being told that testing positive for the genetic markers for celiac disease is a "diagnosis". While I think that, in some cases, a strongly positive result on celiac disease blood tests can eliminate the need for biopsy to confirm, I think that when celiac disease is suspected and tests are negative or unclear, a biopsy should always be performed. I also think there is value in knowing how badly damaged the gut is and in seeing how much healing has been done in a follow-up biopsy at a later date.

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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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