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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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9 Responses:

John S
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said this on
18 Feb 2013 9:35:08 AM PST
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 PST
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 PST
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 PST
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 PST
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 PST
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 PST
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 PST
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 PST
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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From the Chicago Celiac Disease Center which is one of the premier celiac disease research & treatment centers in the world: Are you scheduled for a biopsy? Are you eating gluten? Any changes in your diet can affect the accuracy of your biopsy result...

My panel was the same as yours........all tests positive by large numbers so you can consider yourself a Celiac. Are you very symptomatic? I will add that I did not eat Whole Foods exclusively when healing. I needed to gain weight badly so ate gluten-free bread and a few other things that ...

My allergist did suggest I cut out gluten right away, but I?ll call the GI tomorrow and discuss that. Thank you!

He only did 2 of the full panel & you are positive on one of them, the DGP IgG. It only takes one positive to move on to an endoscopy. Here's the full celiac serum panel: Anti-Gliadin (AGA) IgA Anti-Gliadin (AGA) IgG Anti-Endomysial (EMA) IgA Anti-Tissue Transglutaminase (tTG) Ig...

That's about the most definitive positive across the board that I've ever seen. You're way positive on every one. Keep eating gluten every single day until the endoscopy! You don't have to eat a ton, 1 or 2 slices of gluten bread per day will do it. Orrrrrrrrrrr you could take this time to pig ou...