Massachusetts General Hospital | MassGeneral Hospital for Children

A celiac disease diagnosis—unlike other diseases—does NOT have to start with your physician’s suspicions. If YOU think this disease explains your own physical concerns, here’s what to do:

• Make an appointment with your primary care physician for blood work. Mention that 1 out of 133 Americans likely have celiac disease, which is about FORTY times higher than previously believed in the USA.
• The specific antibody tests you’ll need should include: anti-endomysial antibody (lgA EMA) and anti-gliadin antibody (lgA & IgG), and tissue transglutaminase (tTG IgA). These tests are very sensitive and specific for celiac disease.
• If the results of the antibody test(s) are positive, or your doctor suspects celiac disease, you should next see a gastroenterologist to undergo a small intestine tissue biopsy (endoscopy). A biopsy showing damaged villi in the small intestine is the first half of the "gold standard" to diagnosing celiac disease. The second half of the "gold standard" is improvement of health with the gluten-free diet.

Be aware that the top 5 misdiagnoses for overlooked celiac disease are:

1. Anemia
2. IBS
3. Psychological stress, nerves, imagination
4. Diarrhea
5. IBD

Questions & answers

What are the recommended blood tests to diagnose celiac disease?

There is a particular series of blood tests called the "celiac panel." These tests measure your immune system’s response to gluten in the food you eat.

• tTG-IgA or tissue transglutaminase-IgA
• AGA-IgG or Antigliadin IgG
• AGA-IgA or Antigliadin IGA
• Total IGA
• The presence of tTG antibodies is highly suggestive of celiac disease, while AGA can be elevated also in cases of wheat allergy.

How accurate are the celiac blood tests?

The current diagnostic tests for celiac disease are very accurate, particularly when tTG and anti-endomysial antibodies are elevated. The isolated presence of anti-gliadin antibodies does not necessarily imply that the subject is affected by celiac disease, with the exception of children under the age 2 in which tTG and EMA may not be present.

Is it necessary to have an intestinal biopsy to confirm the diagnosis of celiac disease?

Currently, the intestinal biopsy is the gold standard for the diagnosis of celiac disease, and therefore, is considered essential.