So Confused About Which Lab Tests To Get!

[NancyAdams]

I am very suspicious that my sister has either gluten intolerance or Celiac. And since she doesn't use her computer much and I do, I'm the one who needs to find her the correct tests.

But when I go online to look into tests, I find them very confusing!!

I see antibodies tests, and four! 1) Antigluten, 2) Endomysial, 3) Gliadin and 4) Transglutaminase. But some places, I see only two recommended--the Transblutaminase and another but not sure what the other is since they use abbreviations.

Then I see one test just for the Endomysial antibodies without the other three. I'm confused!

I also see a test which combines #3 and #4 only (gliadin and transglutaminase), but with each there's an IgG and IgA. There's also something with this one called serum IgG quantitation?

And I see a celiac DNA test. Is that needed?

Finally, I found a Celiac test called HLA DQ Association, with two tests, one for DQ2 and DQ8, and typing?

Can you help me understand all the above and which she might need?

Also, if the above are negative, and she still has symptoms, do we just assume she has gluten intolerance, or are there tests for that?

Nancy

[happygirl]

Here are the main tests:

tTG IgA

EMA IgA

AGA IgA

AGA IgG

total IgA

tTG IgA and EMA IgA are the newer/more sensitive/more specific tests.

The total IgA test is not a Celiac test, but it must be run in conjunction with the other IgA based tests. If you are IgA deficient, you cannot test positive on the IgA based tests, so it is necessary to know if you are IgA deficient. If you are IgA deficient, they'll run the tTG IgG test, instead of the tTG IgA test. Being IgA deficient is more common among Celiacs than the average population.

For screening, some doctors run the tTG IgA and the total IgA. Some run the tTG IgA, EMA IgA, and total IgA. Some run all of them. Some only run the AGA IgA and AGA IgG, which are not as sensitive/specific as the newer tests.

Open Original Shared Link

"Serologic panel

Of the commercially available serologic tests that aid in the diagnosis of celiac disease, no one test is ideal. Using multiple serologies increases the diagnostic yield. Therefore, in the United States, screening in patients with possible celiac disease should consist of a panel of the following serologic tests:

Anti-gliadin antibodies (AGA) both IgA and IgG

Anti-endomysial antibodies (EMA) - IgA

Anti-tissue transglutaminase antibodies (tTG) - IgA

Total IgA level."

You'll need to discuss with the doctor which tests they feel are most appropriate. Bring in this literature to aid the discussion.

[NancyAdams]

Hi. Okay, I've combined the abbreviations with the meanings below to help me get it correctly.

tTG IgA/Anti-tissue transglutaminase antibodies

EMA IgA/Anti-endomysial antibodies

AGA IgA/Anti-gliadin antibodies

AGA IgG/Anti-gliadin antibodies

total IgA

So, she does NOT need the Anti-gluten antibodies, or the serum IgG quantitation that I listed above.

And the only reason she'll need the tTG IgG/Anti-tissue transgluatminase antibodies test is if she's low in the4 total IgA, correct??

Just for more info, should she go ahead the do the latter tTG IgG test with the other five??

Nancy

[JennyC]

The most important tests to get for celiac are:

IgA tTG

Total IgA

IgG tTG

The IgA tTG test is the main test for celiac. It's a good idea to get the other tests as well, but make sure that the IgA tTG and total IgA are done.

The genetic test can only exclude the possibility of celiac. Many people have the genes they screen for but do not develop celiac. The genetic test is just another piece to the puzzle for those having a difficult time with a diagnosis, or it could even be used as a screening tool--but it's sadly not.

[NancyAdams]

The most important tests to get for celiac are:

IgA tTG

Total IgA

IgG tTG

The IgA tTG test is the main test for celiac. It's a good idea to get the other tests as well, but make sure that the IgA tTG and total IgA are done.

The genetic test can only exclude the possibility of celiac. Many people have the genes they screen for but do not develop celiac. The genetic test is just another piece to the puzzle for those having a difficult time with a diagnosis, or it could even be used as a screening tool--but it's sadly not.

Hi Jenny. Okay now I'm confused. lol. The other poster stated the tests listed below are the ones needed. I have bolded the ones that you stated (to help me get all this.)

tTG IgA/Anti-tissue transglutaminase antibodies

EMA IgA/Anti-endomysial antibodies

AGA IgA/Anti-gliadin antibodies

AGA IgG/Anti-gliadin antibodies

total IgA

But it looks like you are saying a third test is the tTG IgG/Anti-tissue transglutaminase antibodies which she didn't list. And you didn't list the EMA, or both AGA IgA and IgG.

HELP.

[happygirl]

Please see the link I provided. There is not one perfect test for Celiac, which is why doctors use some or all of the tests listed. It depends on the doctor, the symptoms, and other considerations. You'll need to have this discussion with a doctor experienced with Celiac Disease.

[NancyAdams]

Please see the link I provided. There is not one perfect test for Celiac, which is why doctors use some or all of the tests listed. It depends on the doctor, the symptoms, and other considerations. You'll need to have this discussion with a doctor experienced with Celiac Disease.

Hi. I agree about the doctor, but I also want her to be a very informed patient. Patients have to stop being so passive and unknowledgeable when they walk into the doctor's office! I'll check out the link. Thank you so much.

[Korwyn]

I am very suspicious that my sister has either gluten intolerance or Celiac. And since she doesn't use her computer much and I do, I'm the one who needs to find her the correct tests.

Finally, I found a Celiac test called HLA DQ Association, with two tests, one for DQ2 and DQ8, and typing?

Also, if the above are negative, and she still has symptoms, do we just assume she has gluten intolerance, or are there tests for that?

Hi Nancy,

I just spent several months going through the same thing you are, personally and with my Dad. My doctor was suspecting gluten sensitivity with me, but not being highly knowledgeable about Celiac order only some of the tests, which came back negative. After a couple rounds of negative tests, but extreme improvement of my health after going gluten-free/CF I ordered the complete test from Enterolab (Open Original Shared Link) which did the genetic testing (HLA-DQ testing), the anti-gliadin IGA, anti-tissue IGA, Fat malabsorbtion, and Dairy. Testing. All came back positive, and also showed that I'm carrying two different genes, one from each parent. Enterolab does a cutting edge stool sample and DNA swap for fecal anti-bodies which is more accurate than many of the blood tests. Also because the gluten affected me so badly there was no way I could do a gluten challenge for the biopsy.

I would strongly suggest you look at their test panel A. Insurance may or may not cover it. If you can get the Dr. to order the test you might have better luck, YMMV.

Corwin

[NancyAdams]

Hi again. Called Joan about the information I gleaned here. She came over and handed me the tests that Lab Corp does, and which her doctors uses as well as a on-line facility she has used before--didn't remember to ask the name. Labcorp is within a block of her house. I am thinking #2 is her best bet. Am I correct? I didn't think #1 was because it leaves out the total IGa, even though it has the addition of antigluten. #3 is just three of the four in #2. Am I thinking correctly on this?

Nancy

1:

Antigluten Antibodies

Endomysial Antibodies

Gliadin Antibodies (IgA, IgG, and EIA)

Tissue Transglutaminase (tTG) Antibodies.

2:

Deamidated Gliadin Antibodies

Endomysial antibodies

tissue transglutaminase (tTG) antibodies

Total IgA

3:

Endomysial Antibody (IgA)

tissue transglutaminase, IgA

Total IgA

[NancyAdams]

Forgot to add what was written on the back:

#4

tissue transglutaminase, IgG

tissue transglutaminase, IgA

deamidated gliadin IgA

deamidated gliadin IgG

serum IgA quantitation

1:

Antigluten Antibodies

Endomysial Antibodies

Gliadin Antibodies (IgA, IgG, and EIA)

Tissue Transglutaminase (tTG) Antibodies.

2:

Deamidated Gliadin Antibodies

Endomysial antibodies

tissue transglutaminase (tTG) antibodies

Total IgA

3:

Endomysial Antibody (IgA)

tissue transglutaminase, IgA

Total IgA

[happygirl]

I'd go with 2.

[JennyC]

Hi Jenny. Okay now I'm confused. lol. The other poster stated the tests listed below are the ones needed. I have bolded the ones that you stated (to help me get all this.)

tTG IgA/Anti-tissue transglutaminase antibodies

EMA IgA/Anti-endomysial antibodies

AGA IgA/Anti-gliadin antibodies

AGA IgG/Anti-gliadin antibodies

total IgA

But it looks like you are saying a third test is the tTG IgG/Anti-tissue transglutaminase antibodies which she didn't list. And you didn't list the EMA, or both AGA IgA and IgG.

HELP.

IgG tTG--This can be useful in case the patient is IgA deficient

EMA--The doctors never even ran this on my son, nor are we learning how to run it in my clinical laboratory science program. It is thought to be more specific to celiac, but is less sensitive.

AGA IgA/IgG--These are useful, but not the definitive test for celiac.

I'm sorry if I was not clear earlier, all of the above tests are useful as a part of a panel, but the most diagnostic test is the IgA tTG. This is because the autoimmune aspect of celiac disease is directed toward tissue transglutaminase (tTG). This occurs in the intestine, which is one of a small handful of places in the body where IgA antibodies are produced. Other examples include breast milk or saliva.