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    Do you have questions about celiac disease or the gluten-free diet?

  • Scott Adams
    Scott Adams

    How accurate are blood-antibody tests?*


    There are two classes of antibodies seen in untreated celiac disease. Antibodies directed against a fragment of gluten called gliadin, and antibodies directed against a particular tissue in the body itself. The two main areas in the body which can be attacked by its own antibodies are the aendomysial (the covering of muscle), and the reticulin ( the framework for kidney and liver), but there are others.

    To conduct the test, 5ccs of blood is drawn from the patient, and the blood cells are removed. The gliadin test is usually an automated machine-read test, which means there is little room for interpretor error. However, currently in the USA there is no standard methods for conducting the test, or normal ranges for the results. The endomysial tests are more dependent on the experience and ability of a pathologist who looks at a pattern of staining produced by the patients serum on a slice of monkey esophagus. While this test is done in similar way in most labs, there are many differences in how the results are interpreted.

    How good are these tests?

    If all of the blood test results are positive a celiac disease diagnosis is 90% accurate. However, there are several circumstances in which the tests can be inaccurate. IGA and IGG are two different varieties of antibodies which are produced by most peoples immune systems. There is a different blood test for each of the antibodies. Of the two tests, the IGA gliadin and IGA endomysial tests are the most accurate. However, this test can become negative relatively quickly after going on a gluten-free diet (3-6 months), which can cause a false negative test result. The IGG is less specific, and can sometimes be positive in non-celiacs. Also, about 4% of celiacs have no IgA at all! For these reasons it is very important that both tests are done for an accurate diagnosis. The biopsy is still considered the "standard candle" to confirm a blood diagnosis, and give a 100% sure diagnosis.

    For all tests for celiac disease it is necessary that one is on a gluten-containing diet, or false-negative test results could be given. Blood tests may also be useful in following up a known celiac and confirm that the diet is indeed free of large amounts of gluten. Also, because of the lack of standardization, keep in mind that blood test results may not be directly comparable from one lab to the next.


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    This is crazy...'a slice of monkey esophagus'. I had no idea they were killing monkeys for this. Also, I'm not willing to get on a gluten diet just to have some doctor tell me that I have celiac disease. That's just too risky for me. Although I do like the information about having a gluten test to see the levels of gluten getting into my diet that I am unaware of. Thank you for the information.

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    About two years ago I had a celiac's test. I was told at the time it was negative. Come to find out, now they're saying I was positive for one of the antibodies but not the other. They're redoing the test. If I get the same result, should I push for some other type of test?

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    There's no better indicator for what we need than our bodies own reaction to foods. I came up negative for antibodies, although which ones I am not aware. But when I get gluten in my food by accident, I am acutely aware of it. The immediate reaction is terrible gut pain, bloating and gas and later on my face is mottled by acne and inflammation. Clearly, these tests, although a god send for many, are not always a clear indicator of what is best for our health (as evidenced by the lack of a celiac diagnosis in my case). Some who are experiencing these symptoms but do not come up with antibodies should either look into the biopsy or just try the diet and see what happens. My livelihood was too large a price to pay for the convenience of eating whatever I wish.

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    I agree with Maria. It's not always so clear. My blood test came back positive but when they did the endoscopy there wasn't any visible damage to my small intestines, just severe redness (stomach & small intestines are suppose to be a pale pink color). The doc didn't even bother to take the biopsy. The doctors say that I don't have celiac but just an intolerance to gluten along with gastritis and lactose intolerant. If I eat anything with gluten/dairy I become so sick, you would think I have food poisoning. The doctors don't know much more about the disease then we do by researching it ourselves. They told me to be retested in a year or so, but clearly there won't be any signs because I am forced to eliminate gluten from my diet. I hope that with all the research they are doing on celiac disease, they can develop a more precise way to diagnose.

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    Very informative. I am going through a lot of G.I. problems right now and am having an upper G.I. done on Wednesday to try and find out what's going on. I cut gluten out of my diet about 3 weeks ago in an attempt to see if it would help. It HAS helped to some extent, but not totally. It DID eradicate my diarrhea issues, but not my pain and nausea (which could be cause by something else, I guess.) I am going to request that I be tested for Celiac Disease. I'm glad I read this though - I guess it means I need to eat a sandwich or some crackers or something the day before. Yuck. I DO miss the gluten foods - but have enjoyed being diarrhea-free. I accidentally ate something with gluten and sure enough, the trots came back. (sigh) Anyway - so I guess I'll eat a little gluten prior to the testing.

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    Very informative. I am going through a lot of G.I. problems right now and am having an upper G.I. done on Wednesday to try and find out what's going on. I cut gluten out of my diet about 3 weeks ago in an attempt to see if it would help. It HAS helped to some extent, but not totally. It DID eradicate my diarrhea issues, but not my pain and nausea (which could be cause by something else, I guess.) I am going to request that I be tested for Celiac Disease. I'm glad I read this though - I guess it means I need to eat a sandwich or some crackers or something the day before. Yuck. I DO miss the gluten foods - but have enjoyed being diarrhea-free. I accidentally ate something with gluten and sure enough, the trots came back. (sigh) Anyway - so I guess I'll eat a little gluten prior to the testing.

    If you're still having minor symptoms after eliminating wheat, try eliminating soy or soybean oil too. This can be tedious (read labels on everything - jar spaghetti sauces, salad dressings, soups, butter spreads, chips, microwave popcorn, cereal, Worcestershire, etc.) but worth it! An article my sister sent me four years ago saved me because I was still not 100% well until reading it.

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    My son tested negative to celiac, but it runs in my husbands family, and my son severely reacts to gluten. His Pediactic Gastro. said that they now know that not all patients with celiac will even have a normal IGA response. He said follow the symptoms, not the test results. He also said that when you have celiac disease or a gluten sensitivity, you often become intolerant to soy and dairy (at least for awhile) until your stomach can heal. So, if when you cut out soy it is not helping much, cut out dairy too, or do a Total Elimination Diet for awhile. It sucks, but will help you get to the bottom of all the intolerances (which often cannot be found via a test).

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    There's no better indicator for what we need than our bodies own reaction to foods. I came up negative for antibodies, although which ones I am not aware. But when I get gluten in my food by accident, I am acutely aware of it. The immediate reaction is terrible gut pain, bloating and gas and later on my face is mottled by acne and inflammation. Clearly, these tests, although a god send for many, are not always a clear indicator of what is best for our health (as evidenced by the lack of a celiac diagnosis in my case). Some who are experiencing these symptoms but do not come up with antibodies should either look into the biopsy or just try the diet and see what happens. My livelihood was too large a price to pay for the convenience of eating whatever I wish.

    I completely agree with you Maria!

    My results keep coming back negative, but if I eat anything with gluten my face breaks out horribly and the gas and bloating with stomach pain are unbearable!

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    I've been off gluten for six months now (and am feeling better). Now my MD wants me to do this bloodwork for celiac. She said three days of gluten beforehand--- does this sound like enough? Does anyone know?

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    Very informative! My one year old daughter just had the biopsy and endoscopy test two days ago We are still waiting for results!

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  • About Me

    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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