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Do We Really Need Biopsies to Diagnose Celiac Disease?

Can celiac disease be accurately detected without a biopsy?

Can blood tests alone accurately diagnose celiac disease? Photo: CC--Garland Cannon 07/13/2017 - Until recently, duodenal biopsy was considered the gold standard for diagnosing celiac disease, but that is changing.

A number of studies have shown that celiac disease can be diagnosed using serological tests alone, but many clinicians have yet to embrace this approach.

In both retrospective and prospective studies, one research team showed that certain IgA-tissue transglutaminase antibodies levels can predict celiac disease in adults 100% of the time.

After making some adjustments to the analytical method for measuring the antibody, a team of researchers recently set out to to determine whether such serum tests can reliably diagnose celiac disease in large numbers adult patients without the need for small bowel biopsy.

The research team included GKT Holmes, JM Forsyth, S Knowles, H Seddon, PG Hill, and AS Austin.

They are variously associated with the Royal Derby Hospital, the Department of Pathology, and the Derby Digestive Diseases Centre at the Royal Derby Hospital in Derby, UK.

For their study, the team conducted a retrospective analysis in an unselected series of 270 adult patients who underwent small bowel biopsies and the measurement of serum IgA-tissue transglutaminase antibody levels from 2009 to 2014.

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At an IgA-tissue transglutaminase antibody cut-off greater than 45 U/ml (>8×upper limit of normal+2SDs) the positive predictive value for CD in this cohort was 100%; 40% of cases were above this cut-off.

The team found that they could use IgA-tissue transglutaminase antibody levels to reliably diagnose celiac disease in a high proportion of these adult patients.

This study adds to the growing body of evidence that supports the diagnosis of celiac disease without a mandatory small bowel biopsy.

As a realist of these findings, the study team has changed the diagnostic guidelines for their center, and will now make celiac diagnosis based on cut-off levels of IgA-tissue transglutaminase.

This is exciting news. For many, many years, the biopsy was considered the gold standard for diagnosing celiac disease.

By eliminating biopsies in favor of IgA-tissue transglutaminase levels, diagnosing celiac disease could become much easier and even cheaper.

Do you have celiac disease? Did you receive a biopsy for diagnosis? How do you feel about celiac diagnosis without biopsy? Share your thoughts below.

Source: welcomes your comments below (registration is NOT required).

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16 Responses:

Lois Bemis
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said this on
13 Jul 2017 4:42:03 PM PST
My teenage daughter was diagnosed by a genetic test.

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said this on
17 Jul 2017 4:46:01 AM PST
Good news!

Tracy Hintz
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said this on
17 Jul 2017 8:17:56 AM PST
My daughter was diagnosed in 2006 by colonoscopy. She has the blood test in 2005 and after a negative result on her blood test and suffering another six months until a colonoscopy was finally done. The GI specialist didn't even need to wait for biopsies because of the damage, but of course the biopsies were positive as well. I'm dubious about relying on blood work alone, at least in children. I´d hate to be the patient or the family member or a patient suffering who was told it was negative based on blood alone. We were told because she was vomiting and had diarrhea daily that they suspect the blood test was negative because so little was being absorbed in her system.

Clair C.
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said this on
17 Jul 2017 11:55:33 AM PST
I was tested after a trip to Brazil pointed out to my doctor that I might be celiac. He did just the celiac test and I so conclusively "failed it" that he declared me celiac after 10 to 15 years of not knowing what was wrong with me. There is no question that I am celiac after so many symptoms and so many years of eating gluten free (about 9 years and counting).

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said this on
17 Jul 2017 1:42:40 PM PST
I was also diagnosed by genetic testing. I did not know anything about celiac disease when I was young and having all kinds of stomach issues. I went gluten free because I thought maybe I had a sensitivity to wheat and felt so much better. I later found out about celiac disease and asked my doctor to test me for it and he refused, saying it was very rare and I had IBS which is common in women. I had genetic testing done many years later and all markers were positive, in fact the counselor I talked to said she had been in the field for over 30 years and had never seen anyone with positive markers end up NOT having celiac disease but my Dr. at the time said they would not diagnose me with celiac unless I went back on gluten for a month or so and then had a biopsy. I was not willing to do that because I had been so sick before on gluten that I could not work or do much of anything. It took over 15 years before I finally got properly diagnosed and found doctors that were educated and knowledgeable about the disease.

Joe Hurley
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said this on
17 Jul 2017 3:38:34 PM PST
My blood tests were all negative, but the biopsy showed damage to the small intestine. Does this mean I don't have celiac disease?

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said this on
17 Jul 2017 6:49:26 PM PST
I had the biopsy. The blood work was "borderline" yet I already had serious blunting. My concern is that it might get missed in some cases.

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said this on
17 Jul 2017 8:50:21 PM PST
I was diagnosed by lab work. I have been gluten free since my diagnosis in 2011.

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said this on
18 Jul 2017 2:55:21 AM PST
This would be great; I had a biopsy that didn't show celiac disease, because my physician had the test done after 3 months of gluten free diet! The advise was to skip the gluten free diet and come back for another biopsy after three months! After so many years with pain I just couldn't do that again. So now the physician doesn't believe me. But I am pain free!

Cecelia Brothwell
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said this on
18 Jul 2017 3:50:01 AM PST
I was not tested for celiac disease when I first went to a doctor - tested for a multitude of other things and all negative. Went 3 more years until seeking second opinion. Positive with endoscopy to confirm at which time 3 areas of metaphylasia (sp) were found. One year later on celiac diet, repeat scoping, all areas gone. Now having 3 year scoping as follow up. All pediatricians have this as part of grandchildren's family health history.

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said this on
18 Jul 2017 4:44:17 AM PST
Excellent informative article. Am 75 and have had some scary episodes from anesthesia in the past. I will now no longer do the duodenal biopsy. Had unsymptomatic celiac diagnosed one year ago in a blood test.

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said this on
18 Jul 2017 5:29:59 AM PST
I think that the biopsy is actually not as accurate as physicians would have us believe. In a lecture by Dr. Fasano I attended he admitted that celiac disease is "patchy" and the biopsy may not reach the affected area. If a blood test comes back positive the person has a problem with gluten regardless of the level of damage (Marsh score) and should not eat it.

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said this on
18 Jul 2017 6:51:37 AM PST
12 years ago I had low bone density. Endocrinologist did one test. tTg. Normal was 1-19 mine was 181. Proved part of why my bone density was not good at age 50. I tried to eat well but gluten was in tiny amounts in many places. I didn't know I was celiac, but never ate sandwich or pizza instinctively. I refused the "gold standard" biopsy. I don't see a need for invasive tests when I can change behavior. I am GF. I don't eat GF junk either. I am much better. Still work as I was undiagnosed for so long and am allergic to other things due to leaky gut. I am healthier than most. Wonder if the 25% earlier death is for celiacs that comply. Thanks for your article. I sensed I was wise but people often ask about biopsy. I am now 62.

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said this on
24 Jul 2017 9:28:21 AM PST
I was diagnosed on blood tests alone at age 51, 6 years ago. All of my markers were off the charts high. I had been having unusual blood work for years - high platelets, elevated liver enzymes, thyroid issues, etc. The blood work was so definitive, even after 2 weeks of no gluten, that by the time I saw the gastroenterologist a month later, he did not want to reintroduce gluten and made the diagnosis on blood work - I had the full celiac panel, all markers were high.

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said this on
01 Aug 2017 7:03:57 PM PST
I was just diagnosed with celiac with the blood test - my numbers were extremely high and the doctor gave me the option to do the biopsy. He said with as high as my numbers were it wasn't really necessary if I didn't want it. I have chosen not to get the biopsy done. rnrn

Pam Newbury
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said this on
05 Aug 2017 2:14:17 PM PST
I am surprised to hear two people in the comments say they were "diagnosed" using a genetic test. Genetic tests for celiac disease can, in some cases, exclude a diagnosis of CD, but they cannot diagnose it. One third of the population have the genetic markers for CD. Only a small percentage of those will develop CD. Genetic testing must be followed up by other tests. I am concerned that people are being told that testing positive for the genetic markers for CD is a "diagnosis". While I think that, in some cases, a strongly positive result on CD blood tests can eliminate the need for biopsy to confirm, I think that when CD is suspected and tests are negative or unclear, a biopsy should always be performed. I also think there is value in knowing how badly damaged the gut is and in seeing how much healing has been done in a follow-up biopsy at a later date.

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