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  • Scott Adams
    Scott Adams

    How accurate are blood-antibody tests?*

    Reviewed and edited by a celiac disease expert.

    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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    I recently had a blood test done due to painful stomach aches and it came back positive for celiac. I am going to have the biopsy done on Wednesday (two days from now) I am just wondering, will I fall asleep with the pill they are going to give me? Or will I still be awake? I don't know what the pill is called, but I really don't want to be awake! Also am I still allowed to eat things with gluten in it? Or should I be on a gluten-free diet until they do the test?

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    3 days of gluten is NOT enough. You have to be on a gluten diet for three MONTHS before getting an accurate diagnosis!

    My 6 year old daughter recently had her IGA blood test and the doctor advised she only needed a week for blood results but 6 weeks for biopsy. Having said that her bloods came back negative and the doctor has now wiped us from further tests saying shes not celiac.

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    I had horrible swelling throughout my body, fainting spells, gas bloating and stomach cramps. My results were all positive and high including the biopsy. If I accidently get gluten I know it right away too with horrible cramps.

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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.

    I have no problems with a monkey being sacrificed for a human life or to get a chance at improving a human life. Until there is a better test, use the monkeys to improve our lives.

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    I am 19 and since I was little I have had stomach issues and chronic constipation. Now more recently I am having severe acne issues, and now am missing periods. I had a colonoscopy about a year ago and everything was fine. I went to a gynecologist and she tested my thyroid levels and my general physician said an antibody level was high but the thyroid function was okay. He sent me for blood work to test for celiac because I have a family history on my mom's side. He called with the results today and said "everything was normal". I am so frustrated because all he is doing is giving me medicine to help me go to the bathroom but they either make me sick or don't work at all, the only thing that works is Exlax. I want to push for an upper g.i. but I don't want to waste the time and money if i really don't have it. I don't know what else to do and it seems like since he can't figure out whats wrong he is just giving up. What do I do? Please help.

    Hi Erika, have you tried to see a natural medicine doctor? A year ago, I had a very severe acne issue along with GI problems and Grave disease. The doc told me to increase the dosage of Oroxine and take some contraceptive pills but I did not want to do so. I read a few books from Dr Sandra Cabot regarding the thyroid and I have gained a better understanding about the thyroid and the autoimmune diseases. I started drinking 500ml of the vegetable juice and take Zinc and Selenium daily. After 6 months, my skin was a lot better and now I have a glowing skin that everyone is jealous ofl. I used to be a meat lover but since last year, I became almost a "herbivore". I only eat Atlantic salmon, soy products, legumes, fruits and vegetables and opt for a processed sugar, gluten and dairy free diet. I have so much of energy given that I only sleep 5-6 hours everyday. I am a lot happier, healthier and stronger now. It's true that "you are what you eat"! For a good health always! PS: The books that I have read recently are "Your Thyroid Problems solved", "Raw Juices can save your life" by Dr Sandra Cabot and "Eat to live" by Sue Radd and Dr Kenneth Setchell.

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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.

    Thanks for the HOPE! My 5 year old is going for an endoscopy in 2 weeks and I am nervous about the whole thing; but deep down I know it will be fine, and is the only 100% way to know for sure. Good luck on your gluten-free journey, thanks again.

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    Thanks for the HOPE! My 5 year old is going for an endoscopy in 2 weeks and I am nervous about the whole thing; but deep down I know it will be fine, and is the only 100% way to know for sure. Good luck on your gluten-free journey, thanks again.

    Hi, my son is 12 and is going for a endoscopy in 2 weeks. It has got me ill. I hope all went well for your 5 year old.

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    My doctor says to me, "Doing a full panel for celiac" per my request. No, he did not. They tested for IGA and Immuno A, and that's it. Hardly a "full panel." Test was negative with a result of "2" (considered negative), but I've been almost fully gluten-free for 2 months per the doctor's suggestion, and feel so much better it's like a miracle. My dad died of a gastro cancer and based on his symptoms, I would bet he had celiac disease. I'm going to get a cheek swab for the gene test to be sure. I'm really tired of having to advocate for proper healthcare - why do we pay doctors so much when they can't do the right thing?

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    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!

    Liked your name as so close to mine. I have had two blood test positive but biopsy was negative. However, if I eat gluten like you I have bloating, gum bleeds, face swells and rash and gas. I live on rice with meats and veggies but I've been told that even rice is bad and oats even if they're gluten-free. Do you have any thoughts on this?

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    There are 3 stages of injury to the intestinal lining with gluten sensitivity/celiac disease - Marsh 1, Marsh 2, and Marsh 3. Marsh 1 shows inflammation only. Marsh 2 shows tips of the villi missing, and Marsh 3 shows the villi are gone. Only Marsh 3 is diagnostic of celiac disease.

     

    Blood tests correlate with celiac disease (Marsh 3) 90% of the time. With anything less, the blood tests correlate only 30% of the time. Having normal blood tests may mean you don't have celiac disease (defined as total loss of the intestinal villi), but it doesn't rule out gluten sensitivity (anything less than total loss of the villi).

     

    There is a new lab, Cyrex, that does some novel testing for gluten senstivity/celiac disease, but it is new. I haven't had any experience with it.

     

    The best test is an elimination diet and see what happens. If you feel better, you are sensitive to the food, whether it's gluten or something else. If you have been off of gluten for a while, it may not be a good idea to re-challenge. It can take months for the inflammation to calm down again.

    Great read through all these posts, I have suffered from bloating for years on and off, I have recently come off gluten and it's been 6 days now and I feel great! No bloating, my doctor has given me the forms to get a blood test, but I am reluctant to go back on gluten for two weeks, prior to the test as I have felt so much better. How important is it to have it diagnosed 'celiac' or not? If you are just 'intolerant,' will you eventually go through the marsh 2 and 3 stages? or is it just if you are celiac??

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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.

    That is a werid test and it is not even the only way to test for those specific antibodies. If your blood is A- you likely have it. I have Celiac's disease and my mother is having an ulcer and low blood sugars from it and is in a nursing home undiagnosed! Did you know that one in 22 people have Celiac if a family member has it. If no family member has it is one in 133 people who have it by chance. Doctors do not diagnose this! It could have killed my grandmother! DO NOT CHOOSE IGNORANCE PEOPLE ARE SUFFERING AND DYING FROM A DISEASE THAT OTHER PEOPLE DO NOT BELIEVE EXISTS! In the past if there were not bloating and pain there was no Celiac disease. Think about the people in nursing homes who have not been tested even though they have diabetes and ulcers, clear signs of this rare genetic disease common in certain blood lines. I am in great health but have anemia and low blood sugar! I have celiac it is that subtle! You can go your whole life and not notice the severe internal damage.

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    My doctor says to me, "Doing a full panel for celiac" per my request. No, he did not. They tested for IGA and Immuno A, and that's it. Hardly a "full panel." Test was negative with a result of "2" (considered negative), but I've been almost fully gluten-free for 2 months per the doctor's suggestion, and feel so much better it's like a miracle. My dad died of a gastro cancer and based on his symptoms, I would bet he had celiac disease. I'm going to get a cheek swab for the gene test to be sure. I'm really tired of having to advocate for proper healthcare - why do we pay doctors so much when they can't do the right thing?

    Yes, I agree with you. Why do we pay doctors so much when they don't seem to try to keep up with current studies but instead just "go with the flow" of all the other doctors. I feel as if doctors don't "think" anymore. And if a patient ever suggests what they think may be the cause, the doctors just make you feel like you are crazy! I am an Occupational Therapist that has worked in healthcare for 20 years and I must say that I have become very distrustful of our healthcare system. There are great doctors out there but you have to search for them!

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  • About Me

    Celiac.com's Founder and CEO, Scott was diagnosed with celiac disease  in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. Scott launched the site that later became Celiac.com in 1995 "To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives."  In 1998 he founded The Gluten-Free Mall which he sold in 2014. He is co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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