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  • Jefferson Adams
    Jefferson Adams

    Blood Test Alone Can Diagnose Celiac Disease in Most Children and Adults

    Reviewed and edited by a celiac disease expert.

    A new study supports using serology tests instead of biopsy to diagnose celiac disease in both children and adults. Here's what they found.

    Blood Test Alone Can Diagnose Celiac Disease in Most Children and Adults - Image: CC BY 2.0--kalyan02
    Caption: Image: CC BY 2.0--kalyan02

    Celiac.com 04/04/2022 - Consensus is building among researchers and clinicians for skipping biopsy, and diagnosing celiac disease in both children and adults using antibody tests alone.

    A team of researchers recently set out to assess the diagnostic accuracy of serological tests for celiac disease in adults and children. The research team included Athena L. Sheppard; Martha M. C. Elwenspoek; Lauren J. Scott; Victoria Corfield; Hazel Everitt; Peter M. Gillett; Alastair D. Hay; Hayley E. Jones; Susan Mallett; Jessica Watson; and Penny F. Whiting.

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    They are variously affiliated with the The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK; the Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; the Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK; the Paediatric Gastroenterology Department, Royal Hospital for Children and Young People, Edinburgh, UK; and the Centre for Medical Imaging, University College London, London, UK.

    The team searched seven electronic databases between January 1990 and August 2020 and looked for diagnostic studies that assessed the accuracy of serological tests for celiac disease against duodenal biopsy.  They used QUADAS-2 to determine bias risk, along with bivariate random-effects meta-analyses to estimate serology sensitivity and specificity at the most commonly reported thresholds.

    They included over one-hundred and ten studies covering nearly thirty thousand patients, all in secondary care populations. Due to variations in diagnostic thresholds, they included a subset of studies in meta-analyses. 

    Overall sensitivity and specificity of immunoglobulin A (IgA) anti-tissue transglutaminase were 90.7% and 87.4%, respectively, in adults, and 97.7% and 70.2% respectively in children.

    Overall sensitivity and specificity of IgA endomysial antibodies were 88.0% and 99.6% in adults, and 94.5% and 93.8% in children.

    Anti-tissue transglutaminase sensitivity appears to be sufficient to rule out celiac disease in children. 

    The high specificity of endomysial antibody in adults supports clinical use to rule in celiac disease. 

    This evidence supports the serological diagnosis of celiac disease without biopsy. The research team calls for additional studies in primary care to assess serological testing strategies.

    This news will come as a relief to anyone who has been made to eat gluten for a few weeks, and suffer a biopsy to get a celiac diagnosis. We truly are on a new threshold of celiac diagnosis, where biopsy will soon be a rare tool, and serological testing will deliver an accurate diagnosis.

    Stay tuned for more on this and related stories. 

    Read more in pubmed.ncbi.nlm.nih.gov



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    Guest GFcookiemonster

    Posted

    If this is an antibody test, why doesn't it require the person to have been eating gluten? I am not sure I understand. Thanks.

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    trents
    2 minutes ago, Guest GFcookiemonster said:

    If this is an antibody test, why doesn't it require the person to have been eating gluten? I am not sure I understand. Thanks.

    It doesn't say that you don't have to have been eating gluten before the serological antibody test. It is saying that after you have the antibody test and your test is decisively positive then there is no need to do a gluten challenge after that in order to prevent a false negative for the biopsy since there is no need now for the biopsy.

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    Guest GFcookiemonster

    Posted

    3 hours ago, trents said:

    It doesn't say that you don't have to have been eating gluten before the serological antibody test. It is saying that after you have the antibody test and your test is decisively positive then there is no need to do a gluten challenge after that in order to prevent a false negative for the biopsy since there is no need now for the biopsy.

    I'm sorry, I just don't understand (too many negatives in that first sentence lol).  I think you are saying it's possible to determine if you have celiac with this serological antibody test even if you are on a gluten-free diet. That is, you do not have to eat gluten for this test to be accurate. Do I understand that correctly?  And if this is the case, why would there be antibodies to gluten in the blood if you were not being exposed to it. I am clearly missing something. Thank you so much. 

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    Elizabeth Butler
    4 hours ago, Guest GFcookiemonster said:

    If this is an antibody test, why doesn't it require the person to have been eating gluten? I am not sure I understand. Thanks.

    This is not surprising! I may be a simpleton but I know know three things. One the “healthcare industry” is just that. I’m going on 20 years in healthcare and it’s a business. Sick people drum up ALOT OF BUSINESS. Two: science moves slow especially in medicine. Lastly I learned in basic anatomy that endothelial tissue is found all over the body. The skin and the “skin” of the GI Tract share some qualities. Blood is also the substance that brings life and ends it. So it is no surprise that a blood test shows a reaction to “gluten”. Also for those suffering dermatitis herpetiformis we know the skin shows when we’ve had gluten. As soon as I had an allergy test show a wheal to grasses, I cut gluten and most other grasses out of my dietary choices. I don’t miss them and what they do to my body. My wallet was much happier for it too. I’m not nutritiously void either. Everything offered by grasses can be found in other sources. You just have to branch out from French fries and hamburgers. I’m so glad to see this making headway for celiac. I think just like diabetes it’s insidious nature is downplayed because GI symptoms and surgery MAKE HOSPITALS ALOT OF MONEY! 

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    trents

    Guest GFCookieMonster, See my reply with your quote below.

    Edited by trents
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    trents
    22 minutes ago, Guest GFcookiemonster said:

    I'm sorry, I just don't understand (too many negatives in that first sentence lol).  I think you are saying it's possible to determine if you have celiac with this serological antibody test even if you are on a gluten-free diet. That is, you do not have to eat gluten for this test to be accurate. Do I understand that correctly?  And if this is the case, why would there be antibodies to gluten in the blood if you were not being exposed to it. I am clearly missing something. Thank you so much. 

    The serological test will not be valid if you have been off gluten for a significant period of time, say for weeks. The article is not contradicting this reality. It is saying that if your serological test was indeed strongly positive there is no need to go through the pain and hassle of going back on gluten just to have a biopsy. Is that clearer? I think you were not understanding correctly the point the article was trying to make.

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    Elizabeth Butler
    1 minute ago, trents said:

    The serological test will not be valid if you have been off gluten for a significant period of time, say for weeks. The article is not contradicting this reality. It is saying that if your serological test was indeed strongly positive there is no need to go through the pain and hassle of going back on gluten just to have a biopsy. Is that clearer? I think you were not understanding correctly the point the article was trying to make.

    The point of the article is mute. Science is too slow and hardly any money dedicated to food and nutrition just drugs. It shouldn’t take twenty years to find out blood can tell us just about anything we need to know. It controls everything in our body in one way or another. How many celiacs suffering already knew by their own bodies telling them something was wrong or something is getting better. Instead they listened to a doctor who said “ well we would want to be sure your actually celiac before you just cut out the nutritional value of those foods”. Doctors don’t get much education on nutrition…that should be apparent by looking at the recommendation diets for diabetes and heart disease endorsed by doctors everywhere. How much nutritional value is in a slice of white bread? Or some ritz crackers because that’s what the average person is eating. 

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    JD-New to Celiac
    13 hours ago, Guest GFcookiemonster said:

    If this is an antibody test, why doesn't it require the person to have been eating gluten? I am not sure I understand. Thanks.

    I can only give you my account of why this would make sense and I hope that helps to explain why this is important news. I was misdiagnosed for years and gradually became so ill to a point where I was rapidly losing weight and at a point where I could no longer eat. I am a medium framed 6ft male and was nearing 140 lbs by the time a doctor did testing for celiac. The test results showed tTg Iga levels extremely high and the doctor determined at that moment it was celiac and said a gluten free diet was necessary. I understood that to mean I should go gluten free immediately, which I did. The doctor also said I needed to see a GI doctor for follow up care as he was not a specialist. I called and I called and I called to try and get an appointment. Once I finally did get a GI appointment the earliest they could see a new patient was not for six weeks. I explained the seriousness of my condition at the time and they said they would share that with the GI but I never heard back from them. In the meantime I went off gluten and started to slowly recover and even gain back a few pounds. When I did finally get in to see the GI six weeks later, the first thing he asked was what the problem was. I told him my regular doctor did a blood test and diagnosed me with celiac. I then said the doctor told me to go gluten free. The GI responded with you can't diagnose celiac without doing a biopsy. He then said he would order a biopsy but since I went off gluten I would need to go back on it for two months. I told him I would not go through the agony of going back on gluten. So, I left his office and learned afterwards that the GI refused to treat me any longer. In fact he wrote in his report that I was self diagnosing and managing my own health. I have been gluten free for two years. Since going gluten free my tTg Iga levels have dramatically decreased. I've gained 25 pounds and although I still suffer (as many celiacs do) from a long list of ailments, I am much better since going gluten free. I thank one person on this site for giving me the courage to stand up to the GI and not do as he asked as they followed the same path that I did. There were also many on this site that did not agree. My regular doctor still has me listed as having celiac, but whenever I see a new doctor that question still comes up...did they do a biopsy. It is quite annoying. As I understand it the UK will diagnose an adult with celiac based on a blood test and when certain criteria are met.

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    Guest GFcookiemonster

    Posted

    12 hours ago, trents said:

    The serological test will not be valid if you have been off gluten for a significant period of time, say for weeks. The article is not contradicting this reality. It is saying that if your serological test was indeed strongly positive there is no need to go through the pain and hassle of going back on gluten just to have a biopsy. Is that clearer? I think you were not understanding correctly the point the article was trying to make.

    Yes, thank you so much for the clarification. I do understand now. Appreciate your reply!

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    trents
    32 minutes ago, Guest GFcookiemonster said:

    Yes, thank you so much for the clarification. I do understand now. Appreciate your reply!

    You're certainly welcome! Have a great day.

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    Jessica72ism
    14 hours ago, Elizabeth Butler said:

    The point of the article is mute. Science is too slow and hardly any money dedicated to food and nutrition just drugs. It shouldn’t take twenty years to find out blood can tell us just about anything we need to know. It controls everything in our body in one way or another. How many celiacs suffering already knew by their own bodies telling them something was wrong or something is getting better. Instead they listened to a doctor who said “ well we would want to be sure your actually celiac before you just cut out the nutritional value of those foods”. Doctors don’t get much education on nutrition…that should be apparent by looking at the recommendation diets for diabetes and heart disease endorsed by doctors everywhere. How much nutritional value is in a slice of white bread? Or some ritz crackers because that’s what the average person is eating. 

    The Bible says let thy food by by medicine.

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    trents
    31 minutes ago, Jessica72ism said:

    The Bible says let thy food by by medicine.

    Book, chapter and verse please. Your quote comes from Hippocrates, The Greek physician who is considered to be the father of medicine.

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University. His articles, essays, poems, stories and book reviews have appeared in numerous magazines, journals, and websites, including North American Project, Antioch Review, Caliban, Mississippi Review, Slate, and more. He is the author of more than 2,500 articles on celiac disease. His university coursework includes studies in science, scientific methodology, biology, anatomy, physiology, medicine, logic, and advanced research. He previously devised health and medical content for Colgate, Dove, Pfizer, Sharecare, Walgreens, and more. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of numerous books, including "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

    >VIEW ALL ARTICLES BY JEFFERSON ADAMS

     


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