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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 Allie

    I recently had a blood test done due to painful stomach aches and it came back positive for celiac. I am going to have the biopsy done on Wednesday (two days from now) I am just wondering, will I fall asleep with the pill they are going to give me? Or will I still be awake? I don't know what the pill is called, but I really don't want to be awake! Also am I still allowed to eat things with gluten in it? Or should I be on a gluten-free diet until they do the test?

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    Guest Simone
    3 days of gluten is NOT enough. You have to be on a gluten diet for three MONTHS before getting an accurate diagnosis!

    My 6 year old daughter recently had her IGA blood test and the doctor advised she only needed a week for blood results but 6 weeks for biopsy. Having said that her bloods came back negative and the doctor has now wiped us from further tests saying shes not celiac.

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    Guest PJ Johnson

    Posted

    I had horrible swelling throughout my body, fainting spells, gas bloating and stomach cramps. My results were all positive and high including the biopsy. If I accidently get gluten I know it right away too with horrible cramps.

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    Guest Dan Johnson

    Posted

    This is crazy...'a slice of monkey esophagus'. I had no idea they were killing monkeys for this. Also, I'm not willing to get on a gluten diet just to have some doctor tell me that I have celiac disease. That's just too risky for me. Although I do like the information about having a gluten test to see the levels of gluten getting into my diet that I am unaware of. Thank you for the information.

    I have no problems with a monkey being sacrificed for a human life or to get a chance at improving a human life. Until there is a better test, use the monkeys to improve our lives.

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    Guest Rose
    I am 19 and since I was little I have had stomach issues and chronic constipation. Now more recently I am having severe acne issues, and now am missing periods. I had a colonoscopy about a year ago and everything was fine. I went to a gynecologist and she tested my thyroid levels and my general physician said an antibody level was high but the thyroid function was okay. He sent me for blood work to test for celiac because I have a family history on my mom's side. He called with the results today and said "everything was normal". I am so frustrated because all he is doing is giving me medicine to help me go to the bathroom but they either make me sick or don't work at all, the only thing that works is Exlax. I want to push for an upper g.i. but I don't want to waste the time and money if i really don't have it. I don't know what else to do and it seems like since he can't figure out whats wrong he is just giving up. What do I do? Please help.

    Hi Erika, have you tried to see a natural medicine doctor? A year ago, I had a very severe acne issue along with GI problems and Grave disease. The doc told me to increase the dosage of Oroxine and take some contraceptive pills but I did not want to do so. I read a few books from Dr Sandra Cabot regarding the thyroid and I have gained a better understanding about the thyroid and the autoimmune diseases. I started drinking 500ml of the vegetable juice and take Zinc and Selenium daily. After 6 months, my skin was a lot better and now I have a glowing skin that everyone is jealous ofl. I used to be a meat lover but since last year, I became almost a "herbivore". I only eat Atlantic salmon, soy products, legumes, fruits and vegetables and opt for a processed sugar, gluten and dairy free diet. I have so much of energy given that I only sleep 5-6 hours everyday. I am a lot happier, healthier and stronger now. It's true that "you are what you eat"! For a good health always! PS: The books that I have read recently are "Your Thyroid Problems solved", "Raw Juices can save your life" by Dr Sandra Cabot and "Eat to live" by Sue Radd and Dr Kenneth Setchell.

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    Guest Jennifer

    Posted

    I agree with Maria. It's not always so clear. My blood test came back positive but when they did the endoscopy there wasn't any visible damage to my small intestines, just severe redness (stomach & small intestines are suppose to be a pale pink color). The doc didn't even bother to take the biopsy. The doctors say that I don't have celiac but just an intolerance to gluten along with gastritis and lactose intolerant. If I eat anything with gluten/dairy I become so sick, you would think I have food poisoning. The doctors don't know much more about the disease then we do by researching it ourselves. They told me to be retested in a year or so, but clearly there won't be any signs because I am forced to eliminate gluten from my diet. I hope that with all the research they are doing on celiac disease, they can develop a more precise way to diagnose.

    Thanks for the HOPE! My 5 year old is going for an endoscopy in 2 weeks and I am nervous about the whole thing; but deep down I know it will be fine, and is the only 100% way to know for sure. Good luck on your gluten-free journey, thanks again.

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    Guest Kelly

    Posted

    Thanks for the HOPE! My 5 year old is going for an endoscopy in 2 weeks and I am nervous about the whole thing; but deep down I know it will be fine, and is the only 100% way to know for sure. Good luck on your gluten-free journey, thanks again.

    Hi, my son is 12 and is going for a endoscopy in 2 weeks. It has got me ill. I hope all went well for your 5 year old.

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    Guest Susan

    Posted

    My doctor says to me, "Doing a full panel for celiac" per my request. No, he did not. They tested for IGA and Immuno A, and that's it. Hardly a "full panel." Test was negative with a result of "2" (considered negative), but I've been almost fully gluten-free for 2 months per the doctor's suggestion, and feel so much better it's like a miracle. My dad died of a gastro cancer and based on his symptoms, I would bet he had celiac disease. I'm going to get a cheek swab for the gene test to be sure. I'm really tired of having to advocate for proper healthcare - why do we pay doctors so much when they can't do the right thing?

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    Guest Letitia

    Posted

    I completely agree with you Maria!

    My results keep coming back negative, but if I eat anything with gluten my face breaks out horribly and the gas and bloating with stomach pain are unbearable!

    Liked your name as so close to mine. I have had two blood test positive but biopsy was negative. However, if I eat gluten like you I have bloating, gum bleeds, face swells and rash and gas. I live on rice with meats and veggies but I've been told that even rice is bad and oats even if they're gluten-free. Do you have any thoughts on this?

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    Guest Kathy
    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.

    Great read through all these posts, I have suffered from bloating for years on and off, I have recently come off gluten and it's been 6 days now and I feel great! No bloating, my doctor has given me the forms to get a blood test, but I am reluctant to go back on gluten for two weeks, prior to the test as I have felt so much better. How important is it to have it diagnosed 'celiac' or not? If you are just 'intolerant,' will you eventually go through the marsh 2 and 3 stages? or is it just if you are celiac??

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    Guest infinitely

    Posted

    This is crazy...'a slice of monkey esophagus'. I had no idea they were killing monkeys for this. Also, I'm not willing to get on a gluten diet just to have some doctor tell me that I have celiac disease. That's just too risky for me. Although I do like the information about having a gluten test to see the levels of gluten getting into my diet that I am unaware of. Thank you for the information.

    That is a werid test and it is not even the only way to test for those specific antibodies. If your blood is A- you likely have it. I have Celiac's disease and my mother is having an ulcer and low blood sugars from it and is in a nursing home undiagnosed! Did you know that one in 22 people have Celiac if a family member has it. If no family member has it is one in 133 people who have it by chance. Doctors do not diagnose this! It could have killed my grandmother! DO NOT CHOOSE IGNORANCE PEOPLE ARE SUFFERING AND DYING FROM A DISEASE THAT OTHER PEOPLE DO NOT BELIEVE EXISTS! In the past if there were not bloating and pain there was no Celiac disease. Think about the people in nursing homes who have not been tested even though they have diabetes and ulcers, clear signs of this rare genetic disease common in certain blood lines. I am in great health but have anemia and low blood sugar! I have celiac it is that subtle! You can go your whole life and not notice the severe internal damage.

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    Guest Anna
    My doctor says to me, "Doing a full panel for celiac" per my request. No, he did not. They tested for IGA and Immuno A, and that's it. Hardly a "full panel." Test was negative with a result of "2" (considered negative), but I've been almost fully gluten-free for 2 months per the doctor's suggestion, and feel so much better it's like a miracle. My dad died of a gastro cancer and based on his symptoms, I would bet he had celiac disease. I'm going to get a cheek swab for the gene test to be sure. I'm really tired of having to advocate for proper healthcare - why do we pay doctors so much when they can't do the right thing?

    Yes, I agree with you. Why do we pay doctors so much when they don't seem to try to keep up with current studies but instead just "go with the flow" of all the other doctors. I feel as if doctors don't "think" anymore. And if a patient ever suggests what they think may be the cause, the doctors just make you feel like you are crazy! I am an Occupational Therapist that has worked in healthcare for 20 years and I must say that I have become very distrustful of our healthcare system. There are great doctors out there but you have to search for them!

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  • About Me

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    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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