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Learn more. Newly Diagnosed. Info for Parents. Info for Kids. Gluten-Free in College. Family Testing. Gluten in Medications. These autoantibodies can cause intestinal inflammation and damage in the lining of the intestinal wall as well as other parts of the body, resulting in autoimmune disease. Below are some commonly used lab tests for celiac disease and gluten sensitivity. Feel free to use this section as a reference for the later section which discusses real-life examples that people have shared after receiving a celiac disease test:.
After gliadin the destructive part of the gluten protein crosses the intestinal lining, a special enzyme called tissue transglutaminase binds to gliadin and takes off a portion of the protein. This portion is called glutamine. When positive this test is considered 90 percent sensitive at accurately diagnosing celiac disease because the presence of these antibodies correlates highly with the immune system attacking and destroying the intestinal lining, known as villous atrophy.
Much damage needs to occur to the lining of the small intestine before this celiac disease test shows positive, making it a poor early marker for celiac disease. TTG- IgA is also not a test for gluten sensitivity. Another liability to this most common celiac disease test is that typically only immunoglobulin A IgA is evaluated.
IgA, a part of the immune system primarily found in mucous membranes, such as the small intestine, is the most sensitive for antibody testing, but only when a patient has normal functioning. Total Immunoglobulin A , abbreviated total IgA, is an adjunctive test that should be done to prevent false-negative test interpretation. IgA deficiency is 10 to 15 times more common among patients with celiac disease than in the general population.
If a deficiency is present, all tests utilizing IgA could be falsely negative, causing one to miss the presence of celiac disease or gluten sensitivity.
Low IgA level s suggest inflammation of the intestinal lining and greater chronicity of the disease. A low IgA level may provide some insight into the duration of disease. If IgA sensitivity is suspected or confirmed, measuring IgG in the form of a DGP test is the best alternative, or Cyrex Labs, mentioned below also offer great alternatives. These antibodies develop in reaction to damage to the intestinal lining.
In contrast, as gliadin is absorbed through the intestinal lining, it attaches to the smooth muscle cells of the intestinal wall. This defines them as auto-antibodies. Due to their attack on the smooth muscle of the small intestine, EM antibodies correlate better with damage to the intestine wall.
Studies have supported an accuracy rate of approximately 90 percent for celiac disease. Actually, in one study, EM antibodies were present in percent of individuals when total villous atrophy was present, and therefore like the tTG test, it suffers from a lack of accuracy when only mild damage has occurred to the intestinal lining.
This is a highly specific celiac disease test but it has variable sensitivity of 70 to percent, due to the technical difficulty associated with performing the test. This liability associated with a higher expense makes it more of an adjunctive or follow-up test rather than a first-line screening tool. Gliadin is broken down in the intestine to segments of protein polypeptides called exorphins.
According to Dr. Antibodies to gliadin can bind to nervous system tissue and contribute to many of the neurological symptoms associated with gluten sensitivity such as ataxia, migraine, mood swings, and more. There is no official test that has been approved for testing gluten sensitivity, but many feel that AGA is one of the best we have and both IgA and IgG are tested.
A positive AGA test on a celiac patient can indicate poor adherence to the diet. If you do not carry the genes it is impossible for you to ever develop the disease. Upon that point, everyone is in agreement. However, beyond that, there are some varying opinions. Personally I think having one gene, let alone two is more than enough reason to embark on a gluten-free diet if you are experiencing any health issues.
Of course, following up on a positive genetic test there are some genes that are thought to predispose one to gluten sensitivity vs celiac disease and we often see patients who are clearly sensitive to gluten possessing one of each type.
More research needs to occur in this area. This test is not ordered as frequently due to its lack of sensitivity and specificity as compared to other autoantibodies.
When used, ARA is ordered along with other celiac disease tests as part of a panel. Cyrex Labs — 11 Arrays. Saving the best for last, I want to mention Cyrex Labs that are fairly new on the scene as a lab but are, to date, offering some of the best insights to how a body is being affected by gluten, be it a celiac disease or gluten sensitivity. I mention this lab last as it is a specialty lab and therefore not available from most traditional medical doctors and I dare say that most gastroenterologists have likely never heard of them.
But they provide excellent tools that are currently unavailable elsewhere. Below are some real-life examples that have come to my attention via my blog and practice regarding a celiac disease test and what patients have had to endure regarding the faulty interpretation of their tests.
But I feel horrible. Below is my celiac disease test, what do you think? Then last year everything was pretty much the same but Gliadin IgG It hurts my heart to see such things. To interpret, this gentleman tested positive for non-celiac gluten sensitivity years ago.
However, and this is a BIG however, the doctor neglected to mention that his immune system was definitely having a negative reaction to gluten — something we call non-celiac gluten sensitivity NCGS. The poor man feels horrible and it could have been completely prevented by correctly interpreting the celiac disease test correctly the first time.
Moral of the story: get the most comprehensive test you can. If you see anything abnormal, find someone who can correctly interpret the test. My daughter recently had the following blood work results. CPT coding is the sole responsibility of the billing party.
Please direct any questions regarding coding to the payer being billed. The tests listed by specialty and category are a select group of tests offered. For a complete list of Quest Diagnostics tests, please adjust the filter options chosen, or refer to our Directory of Services. Celiac Disease Diagnostic Panel.
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