A Guide to Celiac Disease Tests

Medically Reviewed By Angelica Balingit, MD
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Steps to diagnosing celiac disease involve examining health history, blood tests, and possibly a biopsy of your intestines. Genetic testing can also confirm the presence or absence of genes specific to celiac disease.  Celiac disease is an autoimmune disorder that damages the small intestine when foods with gluten are eaten. Gluten is a protein in many bread products.

It is estimated that about 1% of people globally have celiac disease and about 2 million people in the United States. 

This article explains the tests your doctor may use to check for celiac disease. It also gives an overview of the conditions and answers some frequently asked questions. 

Blue containers holding rows of blood sample tubes with orange lids
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Antibody tests

When a person with celiac disease eats gluten, their immune system makes antibodies that tell the body that gluten is a threat. Because of this, antibody tests for celiac disease are an invaluable tool in diagnosing and managing this autoimmune condition. 

A positive result of one or more of these laboratory tests can give a good indication that celiac disease is present, but due to the complexity of this condition, additional testing may still be necessary.

Keep in mind that for these tests to be accurate, you need to be currently eating a diet containing gluten. 

Antibody testing involves having a small amount of blood drawn in a lab or your doctor’s office for evaluation. 

Tissue transglutaminase (tTG)

The tissue transglutaminase (tTG) test is typically the first step toward diagnosing celiac disease. It is generally done along with the IgA antibody test. 

About 93% of people with celiac disease who eat a gluten-containing diet will test positive. About 96% of people without celiac disease will have a negative test result.

There is still a slight risk of a false positive test, especially for people with other autoimmune conditions. 

Because of the slight chance of an inaccurate result, other antibody tests may also help diagnose celiac disease. 

Deamidated gliadin peptide (DGP)

The DGP test is less sensitive than the other tests. However, it is helpful in certain circumstances. For example, some experts recommend using the DGP test and the tTg-IgA test in children younger than 2 years of age. Another example is when a person has IgA deficiency.

Endomysial antibody (EMA)

Your doctor may want to run the EMA-IgA test after the tTG-IgA test to make a more definitive diagnosis. Research suggests the sensitivity for this test is 86–100%, and the specificity is 97–100%. While these tests may increase the likelihood that a person has celiac disease, a biopsy is the only definitive test to be sure.

The test’s accuracy may depend on how much damage there is to the intestines. This may result in a less sensitive test in people who have mild celiac disease or for children younger than 2 years old. 

Total serum IgA

Although it is rare for people in the general population to have IgA deficiency, 2–3% of people with celiac disease are deficient in IgA. Adding this test to the tTG test for people who likely have celiac disease may help save time in determining the diagnosis. 

Intestinal biopsies

If any of your serologic tests suggest you could have celiac disease, your doctor will most likely order an upper GI endoscopy with biopsies. A biopsy is the only way for them to definitively diagnose celiac disease.

A GI endoscopy is an outpatient procedure performed by your doctor. It involves your doctor inserting an endoscope — a flexible tube with a camera — to examine the lining of your upper GI tract. While they examine the lining, they will also take small biopsies for further examination. 

Other tests

Several other tests can help your healthcare professional determine whether you have celiac disease or are at risk for the disorder. 

Intestinal fatty acid-binding protein (I-FABP)

When cell damage occurs, cytosolic protein I-FABP is released into your bloodstream. This indicates possible celiac disease. 

Genetic testing

People who have celiac disease carry either one or both of the HLA DQ2 and DQ8 genes. However, 25–30% of the general population also carries this gene. Being a carrier does not necessarily mean you have or will develop celiac disease. It does, however, put you at higher risk for the condition. 

Because celiac disease is a genetic condition, if you have a family member with celiac disease, you may be at higher risk for developing it. 

A negative genetic test lets you know that you may not be at risk for developing celiac disease

If you test positive but have no symptoms, experts recommend screening for celiac disease every 3-5 years. 

What is celiac disease?

Celiac disease is an autoimmune disorder that causes the immune system to react abnormally to gluten, a protein found in wheat, barley, and rye. 

When a person with celiac disease ingests gluten, their body attacks the small intestine causing inflammation, damage to the lining, and ultimately malabsorption of nutrients. 

Celiac disease can lead to several symptoms, such as:

  • stomach pain
  • cramping
  • weight loss
  • fatigue
  • anemia
  • vitamin deficiencies

Currently, there is no cure for celiac disease. However, by strictly avoiding gluten, a person can manage their condition. This helps promote healing of the small intestine and relief from uncomfortable symptoms. 

Learn more about celiac disease.

Frequently asked questions

These are some questions frequently asked about celiac disease. They have been reviewed by Angelica Balingit, M.D.

What are the warning signs of celiac disease?

Common symptoms that could indicate celiac disease include abdominal pain and bloating, diarrhea, or constipation. A person may also experience unexplained weight loss, fatigue, and anemia. If you experience any of these symptoms for an extended period, you should consult your doctor for further testing and diagnosis. 

What is the most accurate test for celiac disease?

The most accurate test for celiac disease is a combination of serologic testing and an intestinal biopsy. With serology, blood tests are looking for antibodies that are associated with the immune system responding to gluten exposure. A biopsy of the small intestine will also accurately identify if there is damage due to consuming gluten. 

What foods can trigger celiac disease?

A person with celiac disease must avoid foods that contain gluten, such as wheat, rye, and barley. Even trace amounts can cause symptoms and damage the digestive system. Also, certain processed foods such as soups, sauces, and dressings often include hidden sources of gluten. It is important to check the labels of all processed foods to avoid flare-ups or further damage.

Summary

Celiac disease is an autoimmune disorder that occurs when gluten causes an immune response in the small intestine. It can lead to malabsorption of nutrients, weight loss, fatigue, and other potentially serious health problems. 

Several tests can help diagnose celiac disease, and the most accurate test for you may depend on your situation. This may include checking your blood for antibodies that rise when you eat gluten or taking a small intestine biopsy.

While there is no cure for celiac disease, following a strict gluten-free diet can allow you to manage the symptoms and condition.

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Medical Reviewer: Angelica Balingit, MD
Last Review Date: 2022 Dec 21
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