Steps for Diagnosis

 Symptoms for Celiac Disease can vary among many different symptoms and levels of severity. The outlined steps below are the general process in which Celiac Disease is diagnosed.

1.DO NOT FOLLOW A GLUTEN FREE DIET BEFORE BEING TESTED
Before testing for Celiac Disease it is crucial to continue eating gluten-filled foods. A false negative on the tests could occur if this is not done.

2. CELIAC DISEASE BLOOD PANEL TEST
Generally testing begins with a blood test ordered by your physician, testing the levels of antibodies in your bloodstream. The three antibodies that they generally test are called anti-tissue transglutaminase (tTG), anti-endomysium (EMA), and anti-deamidated gliadin peptides (DGP). If the levels of antibodies are high you probably have Celiac Disease. However, if your levels are low that still does NOT rule out the possiblity that you still may have Celiac Disease.

Other blood tests that may be ordered are the deficiency of IgA if symptoms are present, but a false negative occurs on the blood test panel. Those with a low IgA score of close to zero or less than 10mg/dl require a different panel than listed above. These include the tTG, EMA, IgG. This is for a more accurate diagnosis, but not Celiac Disease in general.  tTG is a very specific and sensitive test for Celiac Disease. 98% of those with Celiac Disease will have an elevated tTG though it may offer some "false positives."  EMA-IgA are also very specific, but not as sensitive as the IgA. HLA-DQ2 and HLA-DQ8 are gene tests for Celiac Disease and do not depend on a gluten diet. If this test is tested negative, Celiac Disease is ruled out for life.

3. SMALL BOWEL BIOPSY
The next step is a small bowel biopsy. In a normal small bowel, vili (small hair like projections) cover the bowel lining. A person with untreated Celiac Disease has vili that have shrunk and flattened in an inflammatory response to gluten. The doctor takes a biopsy to visually see if damage has been done to the small bowel

4. GLUTEN FREE DIET RESPONSE
In final conclusion of diagnosis, if  improvement of health occurs after eating gluten free Celiac Disease is confirmed.


References:

• Antibody Blood Tests (n.d.): 1-2. The University of Chicago Celiac Disease Center. Web. <http://www.cureceliacdisease.org/wp-content/uploads/2011/09/CDCFactSheets3_Antibody.pdf>.