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Intestinal Biopsy is Not Necessarily Required to Diagnose Celiac Disease 02/18/2013 - Currently, there are two main diagnostic tools available to would-be celiacs: biopsy and serological (antibody) tests. For the past few decades, biopsy has been the only relatively reliable (and diagnostically accepted) path to diagnosis. The problem is, biopsies are expensive and highly invasive – antibody tests would be a cheap and painless alternative, but they haven't proven themselves to be accurate enough for conclusive diagnosis. However, a recent analysis shows that antibody tests have improved a great deal in recent years and when used to test for multiple antibodies concurrently, they can be almost as effective as biopsies for diagnosing celiac disease.

Photo: CC--Andy GThe study's facilitators began their restrospective analysis by collecting serum samples from 268 patients at hospitals throughout Switzerland, Germany and Austria. All included patients suffered from celiac-like symptoms and underwent both biopsy and antibody testing within 2 months of serum collection. All included patients were on gluten-containing diets at the time of testing. 149 of the patients were ultimately diagnosed with celiac disease; the other 119 showed normal intestinal mucosa and were considered celiac-free. These patients were the control group.

Usually, potential celiac patients are tested for IgA anti- tTG or EMA. If the test is positive, then diagnosis is then confirmed with biopsy. However, there is still a chance that the test will throw a false positive, meaning many people are put through unnecessary biopsies. The goal of the present study was to develop a method for reducing the number of these unnecessary biopsies.

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It was found that when two antibody tests are used, the reliability of the tests increased substantially, weeding out a great many false positives, as well as picking up some false negatives. When three tests were used, the numbers became even more accurate – when used concurrently and all three show a positive result, the IgA anti-dpgli, igG anti-dpgli and IgA anti-tTG achieved an 87% positive likelihood and .01% negative likelihood (compared to a positive likelihood of only 7% and negative likelihood of 0.04% with just the IgA anti-tTG). Using these three tests together, only one test subject came through as a false positive, and only two came through as false negatives (compared to 16 false positives and 5 false negatives with the IgA anti-tTG only). 60 came through with discordant results (meaning at least one of the tests came back negative – in these cases, biopsy is necessary).

When considering that biopsy really only has a real-world diagnostic accuracy rate of about 90%, the three test combination utilized in this study achieves strong enough numbers that biopsies are starting to look unnecessary. Biopsy still might be the surest way of detecting celiac disease, but this study shows that it is not necessary in all cases, and patients seeking celiac diagnosis have a few more tests they can ask their doctors for.

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  • Can Celiac Disease be Diagnosed without Intestinal Biopsy? 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.... [READ MORE]

9 Responses:

John S
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said this on
18 Feb 2013 9:35:08 AM PDT
I wonder if these trio of tests would also be best for followup testing. After 5 years of being on the diet, with no "cheating" I still have a positive tTg IgA, and it may vary between labs.

Erin Coleman
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said this on
26 Feb 2013 8:39:20 AM PDT
I wanted to respond to your post. This may help others out. The problem I'm encountering is my body is responding to airborne gluten protein being emitted in the form of steam. I'm inhaling it when I breath. even though I'm not eating it. Just breathing it, I have the bloating and all the other symptoms going on. I can feel it as soon as it hits me. I am so allergic to it that my allergist has armed me with 4 epinephrine shots. He probably would think I was crazy except he's known me for 25 years and I've landed in the hospital at least 5 times. This is totally uncharted territory. There are no scientific studies to this date being done to address this problem. Maybe this is something you may want to consider.

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said this on
13 Jun 2013 9:59:40 AM PDT
Erin, have you looked into the Specific Carbohydrate Diet? A small percentage of celiac patients do not feel better after going only gluten-free. Many think they're suffering from gluten that they eat through cross-contamination and/or that they breathe or touch. After going on the SCD, they don't suffer celiac symptoms anymore and finally begin to heal. I recommend you look into it.

someone with Celiac
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said this on
17 Feb 2014 4:41:50 AM PDT
I thought that I was the ONLY Celiac to get sick this way. My husband bakes chocolate chip cookies every year. I stay out of the kitchen. He cleans the kitchen top to bottom. I get so sick and have been to the hospital several times from being so sick. Yet, there are even celiac's who claim this is all in my head!

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said this on
21 Apr 2013 9:10:23 AM PDT
Yes, blood tests for CD, gluten/gliadin intolerance, and food intolerance are good ways to monitor patient compliance when being on an allergen-free protocol. Even more, the at-home kits for CD and food intolerance are an easy and cost-effective way for both physicians and individuals to verify if known allergens are not getting into one's diet.*

*Note: You can find these at-home kits on-line by doing a search in Google for "At-Home 96-Food IgG ELISA Food Intolerance Screening Kit". Good luck!

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said this on
25 Feb 2013 4:55:54 PM PDT
I feel the tests were done by qualified people who understand celiac disease.

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said this on
25 Feb 2013 5:00:43 PM PDT
Ratings, I believe can vary depending on the toxins we have in our body at the time. I take my nutritional stem cell products and leave the results up to God. I'm aware of some of the toxins in body. I can't avoid all of them.

Kevin Stewart
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said this on
25 Feb 2013 7:29:43 PM PDT
About 20 years ago, after trying all kinds of things to account for my lack of iron, my GP sent me to a specialist. During my visit, the specialist spent most of his time studying my fingernails. He then made an appointment for me at his hospital office. He used a scope down my throat. It only took a few minutes and he was able to tell me about the sad condition of, or rather a lack thereof, my villi. Luckily for me, after weaning off of the iron and folic acid, the nubs still worked.

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said this on
26 Feb 2013 1:20:22 AM PDT
Unfortunately, both positive biopsies and the three positive blood test results really mean that the celiac disease has been allowed to progress sufficiently that there is agreement that there is pretty widespread damage. Couldn't we act before there's such severe confirmation of disease? If one of the blood tests is positive, wouldn't that be a hint that something might need to be changed? It took 10 years, but my son's positive antibody test finally turned into the three positive markers for celiac disease. Our pediatrician was worried that we would take gluten out of his diet before he had the disease. I wonder if we could have prevented that by going gluten-free earlier.

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All Activity Celiac Disease & Gluten-Free Diet Forum - All Activity

Hi Allie and welcome First off, I know 3 years was a long wait, but at 17 you've figured out celiac way before many people do. That should make a big impact on minimising its effects and helping you with the diet, so, bizarrely enough, congratulations! A lot of good advice has been brought together in this thread: Don't worry that your symptoms are bad now. As you follow the diet your body will begin healing itself and you're still very young so hopefully this will go really smoothly. Think in terms of the next 6 months rather than weeks however, recovery will likely take a little time. Eat as healthily as you can, lots of whole foods and try to avoid the gluten free processed substitutes as your digestive system needs all the help it can get at this moment. You may want to avoid dairy as well for now and think about reintroducing it later. This site has been really helpful to me and others. I hope you find it just as useful. Best of luck! ps, your increased reaction to gluten during the challenge phase was perfectly normal. Many find that reintroducing it much worse than the initial affects and take some time to get over the challenge. That's why you'll see lots of posts here urging folks to 'stay on gluten' till their testing is complete!

Hi! My daughter is 19 was diagnosed at age 16. It took about 12-18 month s for her to fully heal from the damage and feel "normal" again. Also because of the damage done she had reactions to dairy, so you may want to try no or minimum dairy until youre fully healed. Just a suggestion. Hope you start feeling well soon!

Hi yall! New to this blog, but really glad it exists because I have lots of questions. First off, I'm Allie! I'm 17 and newly diagnosed Celiac after about 3 years of searching for answers. I initially went gluten-free on the recommendation of a friend, I felt better in about a month and then my pediatric gastroenterologist had me do the gluten challenge, and my symptoms were the worst they have ever been, and ones I barely noticed before became very present. I did the biopsy and was diagnosed, it's been about 2 weeks and my symptoms are still pretty bad, although my diet has no known sources of gluten or cross contamination. Wondering if anyone has any input on healing post gluten challenge, any tips or how long it took for you would be quite helpful! Thanks

Might want to look into a keto diet, I have UC on top of celiacs and keto is working great Yeah I have major nerve and brain issues with gluten, gluten ataxia with nerve issues and brain issues. Seems to cause my body to attack my brain and nerve system. My brain stumbles fogs, and starts looping, the confusion causes me to become really irritable, I call it going Mr Hyde. Like my mind will start looping constantly on thoughts and not move driving me literally mad, or it used to. Now days it is primary the numbness anger but the gut issues and sometimes random motor loss limit me motionless to the floor now days for the duration of the major anger effects. Used to be a lot more mental then painful gut. I did a mental trauma post on it on while back where I came out about all my mental issues with gluten.

^^^^^^ good info, tips and tricks^^^^^^^^^ yes, crumbs will make you sick. also, breathing flour/pancake mix, etc that is in the air because eventually, you're going to swallow some.