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  • Scott Adams

    How Accurate are Celiac Disease Blood Antibody Tests?

    Scott Adams
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    Reviewed and edited by a celiac disease expert.

      Just how reliable are blood antibody tests for screening celiac disease?


    Celiac disease blood tests are very accurate. Image: CC BY 2.0--tuckerives
    Caption: Celiac disease blood tests are very accurate. Image: CC BY 2.0--tuckerives

    Celiac.com 05/01/2020 - If you have celiac disease symptoms, for example chronic diarrhea, anemia, bloating, abdominal pain, anemia, etc, your doctor may order a blood test for celiac disease. Note that you must be eating gluten daily for at least 4-6 weeks to be accurately tested celiac disease, otherwise you may end up with false negative results.

    For a celiac disease antibody test, a clinician collects a small amount of the patient's blood. The sample is then sent to a lab, where the blood cells are then removed, and the test is conducted.

    Celiac Disease Blood Antibody Screening is ~98% Accurate When Done Using This Protocol 



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    A celiac disease blood panel includes several tests to determine whether someone has celiac disease. These tests are very specific because certain antibodies only appear in those with gluten sensitivity, celiac disease and/or dermatitis herpetiformis. 

    Testing begins with a test called Immunoglobulin A (IgA). If the results are normal, then a Tissue transglutaminase, antibody, IgA test is given. A weak positive should lead to the following tests:

    1. Endomysial antibodies (IgA) and;
    2. Gliadin (deamidated) antibody, IgA.

    If the initial Immunoglobulin A (IgA) test is low, then these two tests should be done:

    1. Tissue transglutaminase antibodies, IgA and IgG profle.
    2. Gliadin (deamidated) antibodies evaluation, IgG and IgA.

    If the initial Immunoglobulin A (IgA) test is deficient then these two tests should be done:

    1. Tissue transglutaminase (tTG) antibody, IgG.
    2. Gliadin (deamidated) antibody, IgG.

    It sounds complicated, but it's pretty standard procedure now, and when blood screening is done this way the results for celiac disease are ~98% accurate.

    Children Should Now be Diagnosed Using Only Blood Tests and No Biopsy

    In most cases, it is no longer necessary to use biopsy to diagnose celiac disease in children

    Biopsy Still Standard in Adult Celiac Diagnosis

    After positive blood tests some doctors still require a biopsy to confirm the diagnosis. However, this is changing, as new techniques allow doctors to accurately detect celiac disease in adults without a biopsy.

    Remember, nearly all tests and screening for celiac disease require the patient to be eating a gluten-containing diet before testing, usually for at least 4-6 weeks before testing. Be sure to check with your doctor for the latest protocol.

    Blood Tests for Follow Up Care

    Blood tests may also be useful in follow up care in those with celiac disease to confirm that their diet is indeed free 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.

    More Celiac Disease Testing Resources

    Blood Test Questions on the Celiac Disease and Gluten-Free Forum

    Edited by Scott Adams

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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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  • About Me

    Scott Adams 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. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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