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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 Pola

    I think that a diet based on Raw food is the best for everybody. And sure for celiac people. Try it. It's natural and its according to our physiology. Blessings to all.

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    Guest Tootie

    Posted

    There are 3 stages of injury to the intestinal lining with gluten sensitivity/celiac disease - Marsh 1, Marsh 2, and Marsh 3. Marsh 1 shows inflammation only. Marsh 2 shows tips of the villi missing, and Marsh 3 shows the villi are gone. Only Marsh 3 is diagnostic of celiac disease.

     

    Blood tests correlate with celiac disease (Marsh 3) 90% of the time. With anything less, the blood tests correlate only 30% of the time. Having normal blood tests may mean you don't have celiac disease (defined as total loss of the intestinal villi), but it doesn't rule out gluten sensitivity (anything less than total loss of the villi).

     

    There is a new lab, Cyrex, that does some novel testing for gluten senstivity/celiac disease, but it is new. I haven't had any experience with it.

     

    The best test is an elimination diet and see what happens. If you feel better, you are sensitive to the food, whether it's gluten or something else. If you have been off of gluten for a while, it may not be a good idea to re-challenge. It can take months for the inflammation to calm down again.

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    Guest marylworth@yahoo.com

    Posted

    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.

    Do you still have the article? Can you post it?

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    Guest Sherry

    Posted

    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.

    Not only wheat and soy can cause this type of distress, but also corn. I have the double whammy of no corn, no gluten. This makes eating very difficulty--but far better than ending up bent over in pain.

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    Guest Stephanie

    Posted

    I've been having problems with my stomach for two years now. My doctor thought it was my gallbladder but, i did an ultrasound and they said it was all fine. My doctor said it was my birth control, she took me off and gave me something else, but as always it didn't work. I'm having stomach pains, bloating, extreme gas, and getting nausea. Well, i got the blood test done the other day because, my friend has it and she told me it sounds just like her problems. Well, they both came back negative and I want to get a endoscopy done to see. But, if i go two days without eating gluten products my stomach starts to feel a little better but when i go right into eating again it starts bloating, stomach pains, extreme gas, and nausea.

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    Guest Dawn Penland

    Posted

    Does anyone else get rhinitis (stuffy runny nose and sneezing) during their reactions or is it strictly gastro-intestinal for you?

    I get a runny nose the morning after I eat gluten.

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    Guest Mere
    Does anyone else get rhinitis (stuffy runny nose and sneezing) during their reactions or is it strictly gastro-intestinal for you?

    I get a very itchy nose (externally, like the skin on the end of my nose), bloodshot itchy eyes, nosebleeds, I had erythema nodosum, headaches, acne, and about 20 other symptoms of the approximate 300. This all in addition to the stomach pain, and other gastro issues.

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    Guest Dana
    My GI doctor told me there is no way to diagnose just on the blood test. My doctor told me the same thing yours did. I was way off the chart as well...she told me I had celiac and to go on a gluten free diet. My GI doctor was very upset that she told me to go on the diet BEFORE I saw him. He said he HAS to do a biopsy to say I have celiacs.

    From what I understand, the blood test CAN be sufficient to determine a gluten intolerance, BUT in order to know if you have celiac disease, you need the biopsy. Celiac disease involves the deterioration of the villi which line the small intestine, and this is only confirmed through biopsy. However, you can have a significant gluten intolerance and not have celiac disease. Celiac is just one of the many possible side effects of eating gluten if you are intolerant. the body does not produce antibodies against something unless it is harmful to you. Therefore, the positive blood work could be considered enough to determine your gluten intolerance, and spare yourself or your little ones the expense and trauma of an endoscopy. Unless of course you really want to have the celiac diagnosis, eliminating gluten will provide amazing health benefits either way to the gluten intolerant individual.

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    Guest Gabriella

    Posted

    Does anyone else get rhinitis (stuffy runny nose and sneezing) during their reactions or is it strictly gastro-intestinal for you?

    No, but in my reaction, I get extremely itchy and red and patchy skin particularly on my chest and face and extreme acne flair ups within minutes of consumption among the gastrointestinal effects. I read that "food allergies" particularly cause your symptoms and they can be celiac-related so I would try to avoid completely the foods that cause that reaction in you as this is a sign that your body is not taking to well to it.

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    Guest Amy

    My total SIgA (saliva) was 6 (depressed- normal is (25-60)) and Gliadin Ab, SIgA (Saliva) was 1 (positive is >15). Which is a negative result. Could my SIgA Gliadin be lower since my SIgA is very low? (I have no other known conditions). Should I try to get a blood test? Is that more accurate than saliva? Where to go from here?

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    Guest Maria

    Hi everyone. I am recent to this celiac and am from a developing country...so little gluten free diet options here. My igA is 118 on a retest after I was on a gluten free diet for 6 months. Previously it was 284 (normal is less en 10). My igG was 604 but it is normal this time (4). So my doc says I don't need a biopsy. My tests are sufficient. AND now with this repeat test he has put me on steroids for a week...confusing.

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    Guest Jodi
    From what I understand, the blood test CAN be sufficient to determine a gluten intolerance, BUT in order to know if you have celiac disease, you need the biopsy. Celiac disease involves the deterioration of the villi which line the small intestine, and this is only confirmed through biopsy. However, you can have a significant gluten intolerance and not have celiac disease. Celiac is just one of the many possible side effects of eating gluten if you are intolerant. the body does not produce antibodies against something unless it is harmful to you. Therefore, the positive blood work could be considered enough to determine your gluten intolerance, and spare yourself or your little ones the expense and trauma of an endoscopy. Unless of course you really want to have the celiac diagnosis, eliminating gluten will provide amazing health benefits either way to the gluten intolerant individual.

    So my question in my case is if my blood test came back barely positive but my endoscopy came back negative should I stop eating gluten? My doctor told me that if I don't have any symptoms that it is ok to eat it. Your thoughts????

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  • About Me

    Scott Adams

    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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