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    Celiac Disease Blood Antibody Tests

    Reviewed and edited by a celiac disease expert.

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

    Celiac Disease Blood Antibody Tests - 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 02/05/2023 - If you have celiac disease symptoms, for example chronic diarrhea, anemia, bloating, abdominal pain, rashes, are in a higher risk group, etc., your doctor may order a blood test for celiac disease. Note that before doing any blood tests for celiac disease you must be eating gluten for a while beforehand, and the amount and length of time can vary, but is somewhere between 2 slices of wheat bread daily for 6-8 weeks and 1/2 slice of wheat bread or 1 wheat cracker for 12 weeks, 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 Tests

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    Note that the accuracy and specificity of each test can vary depending on the laboratory performing the test, the specific method used, and the population being tested. Sensitivity refers to the ability of a test to correctly identify individuals with the condition (true positive rate), while specificity refers to the ability of a test to correctly identify individuals without the condition (true negative rate).

    tTG-IgA (tissue transglutaminase IgA) Blood Test for Celiac Disease

    This test measures the levels of IgA antibodies to tissue transglutaminase, an enzyme that is involved in the immune response to gluten in those who have celiac disease.

    The test is estimated to have a sensitivity of approximately 90%, which means that it correctly identifies 90% of people with celiac disease. It also has a high specificity of around 95%, which means that it correctly identifies 95% of people who do not have celiac disease.

    Other Names for the tTG-IgA Test:

    • Tissue Transglutaminase IgA Test
    • Anti-Tissue Transglutaminase IgA Test
    • tTG-IgA Blood Test
    • tTG-IgA Serology Test
    • IgA-tTG Antibody Test
    • Tissue Transglutaminase Antibody IgA Assay

    tTG-IgG (tissue transglutaminase IgG) Blood Test for Celiac Disease

    This test measures the levels of antibodies to tissue transglutaminase, but it specifically measures IgG antibodies rather than IgA antibodies which are produced in people who eat gluten and have celiac disease. It is not as sensitive or specific as the tTG-IgA test, but it may be useful in cases where a person has an IgA deficiency, which can occur in approximately 2-3% of people with celiac disease. In these cases, the tTG-IgG test may be positive while the tTG-IgA test is negative. However, the tTG-IgG test is not recommended as a first-line screening test for celiac disease.

    The sensitivity of the tTG-IgG blood test is generally high, ranging from 85% to 98%. This means that the test can accurately detect celiac disease in a significant percentage of people who have the condition.

    The specificity of the tTG-IgG blood test is also high, typically around 90% to 98%. This indicates that the test can effectively rule out celiac disease in individuals who do not have the condition.

    Other Names for the tTG-IgG Test:

    • Tissue Transglutaminase IgG Test
    • Anti-Tissue Transglutaminase IgG Test
    • tTG-IgG Blood Test
    • tTG-IgG Serology Test
    • IgG-tTG Antibody Test
    • Tissue Transglutaminase Antibody IgG Assay

    EMA-IgA (endomysial antibodies IgA) Blood Test for Celiac Disease

    This is a highly accurate test for celiac disease, that requires specialized expertise to perform and interpret, and it is more expensive than other blood tests. It is generally used as a last test to confirm celiac disease after a positive tTG-IgA test.

    The sensitivity of a test refers to its ability to correctly identify individuals with the condition. For the EMA-IgA blood test, the sensitivity is generally very high, ranging from 90% to 98%. This means that the test can accurately detect celiac disease in a significant percentage of people who have the condition.

    The specificity of a test refers to its ability to correctly identify individuals without the condition. For the EMA-IgA blood test, the specificity is also high, typically around 95% to 100%. This indicates that the test can effectively rule out celiac disease in individuals who do not have the condition.

    Other Names for the EMA-IgA Test:

    • Endomysial Antibodies IgA Test
    • Anti-Endomysium Antibodies IgA Test
    • Endomysial Antibody IgA Assay
    • EMA IgA Blood Test
    • EMA-IgA Serology Test
    • Endomysium IgA Ab

    DGP-IgA and DGP-IgG (Deamidated Gliadin Peptide) Blood Tests for Celiac Disease

    These tests measure the levels of antibodies in the blood, but specifically targets deamidated gliadin peptides, which are a type of gluten protein that can trigger an immune response in people with celiac disease. The tests are not always included in adults, but should be in cases with IgA deficiency. The tests should always be included when screening children, especially if they are under 2 years old. The DGP tests were created to detect celiac disease in those with IgA deficiency, and there are here is more information about them:

    • DGP-IgA Test: This test measures the levels of IgA antibodies specific to deamidated gliadin peptide. IgA antibodies are produced by the immune system in response to gluten exposure. In individuals with celiac disease who produce normal levels of IgA, a positive DGP-IgA test result suggests the presence of ongoing immune response to gluten.
    • DGP-IgG Test: The DGP-IgG test measures IgG antibodies against deamidated gliadin peptide. IgG antibodies are another type of immune response and may be elevated in individuals with celiac disease who have IgA deficiency (a common occurrence in celiac disease).

    The DGP-IgA test is considered to have high sensitivity and specificity. In general, the DGP-IgA test has been reported to have a sensitivity ranging from 75% to 95% and a specificity ranging from 90% to 100%. Overall, the DGP tests, including DGP-IgA and DGP-IgG, exhibit a sensitivity of approximately 85-95% and a specificity of about 95-98%.

    Other Names for the DGP-IgA Test:

    • Gliadin Peptide Antibody IgG (Immunoglobulin A)
    • Anti-Gliadin Antibody IgA (AGA IgA)
    • Anti-Gliadin IgA Antibody (AGA IgA)
    • Anti-Gliadin IgA (AGA IgA)
    • Anti-Gliadin Immunoglobulin A Antibody (AGA IgA)
    • Anti-Deamidated Gliadin Peptide IgA (DGP IgA)
    • Anti-Deamidated Gliadin Antibody IgA (DGP IgA)

    The sensitivity of the DGP-IgG test is reported to range from 75% to 85%, which means it can correctly identify individuals with the condition in about 75% to 85% of cases. The specificity of the DGP-IgG test is reported to range from 75% to 95%, which means it can correctly identify individuals without the condition in about 75% to 95% of cases. Overall, the DGP tests, including DGP-IgA and DGP-IgG, exhibit a sensitivity of approximately 85-95% and a specificity of about 95-98%.

    Other Names for the DGP-IgG Test:

    • Gliadin Peptide Antibody IgG (Immunoglobulin G)
    • Anti-Gliadin Antibody IgG (AGA IgG)
    • Anti-Gliadin IgG Antibody (AGA IgG)
    • Anti-Gliadin IgG (AGA IgG)
    • Anti-Gliadin Immunoglobulin G Antibody (AGA IgG)
    • Anti-Deamidated Gliadin Peptide IgG (DGP IgG)
    • Anti-Deamidated Gliadin Antibody IgG (DGP IgG)

    IgA Levels/Deficiency Blood Test

    This should always be included in any blood panel for celiac disease, but it does not test directly for celiac disease, and is done to determine the accuracy of the other blood tests. People who are IgA deficient may score lower, of have no measurable levels on certain celiac disease blood tests. This test measures the levels of Immunoglobulin A (IgA) in the bloodstream. IgA is an important antibody that plays a significant role in the immune system, particularly in protecting the body's mucosal surfaces (e.g., respiratory and digestive tracts). Low IgA levels can indicate IgA deficiency, a condition where the body does not produce enough IgA, leading to an increased risk of infections and other health issues. The IgA Levels/Deficiency Test helps healthcare providers diagnose and monitor IgA-related conditions.

    Other Names for the IgA Levels/Deficiency Test:

    • Immunoglobulin A (IgA) Test
    • Total IgA Test
    • Serum IgA Test
    • IgA Serum Levels Test
    • IgA Blood Test
    • IgA Quantitative Test
    • IgA Antibody Test
    • IgA Immunodeficiency Test

    Celiac Disease Blood Antibody Screening is ~98% Accurate in Adults Using the Mayo Clinic Protocol 

    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 lower than normal, 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 below the level of detection (<1.0 mg/dL), 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.

    Many People Can Be Diagnosed Using Only Blood Tests and No Biopsy

    According to the latest research, if the blood test results are at certain high levels that range between 5-10 times the reference range for a positive celiac disease diagnosis, it may not be necessary to confirm the results using an endoscopy/biopsy:

    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 you should be eating at least 1/2 slice of wheat bread or 1 wheat cracker daily for at least 2 weeks before the endoscopy. 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

     

    Read more at mayocliniclabs.com



    User Feedback

    Recommended Comments



    Guest Ginger

    Posted

    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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    Guest Jen

    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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    Guest Maria

    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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    Guest Beth

    Posted

    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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    Guest Jan

    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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    Guest Patricia

    Posted

    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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    Guest Michelle

    Posted

    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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    Guest Leticia

    Posted

    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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    Guest Valerie

    Posted

    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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    Guest Kara

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

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    Guest Harvey Dessel

    Posted

    This article and the blog were very helpful.

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    Guest Meredith

    Posted

    Very informative! My one year old daughter just had the biopsy and endoscopy test two days ago We are still waiting for results!

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    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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