Celiac Disease Tests

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Also known as: Gluten-Sensitive Enteropathy Tests; Anti-tissue Transglutaminase Antibody; tTG or tTGA; Anti-Gliadin Antibodies; AGA; Anti-Endomysial Antibodies; EMA; Deaminated Gliadin Peptide Antibodies; DGP; Anti-Reticulin Antibodies; ARA

At a Glance

Why Get Tested?

To help determine whether you have celiac disease and to evaluate the effectiveness of a gluten-free diet

When to Get Tested?

When you have symptoms suggesting celiac disease, such as chronic diarrhea, abdominal pain, anemia, and weight loss; when an infant is chronically irritable or fails to grow at a normal rate; when a family member has celiac disease; to monitor treatment of celiac disease

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

Follow your doctor's instructions. For diagnosis, ingestion of gluten-containing foods for a time period, such as several weeks, is necessary. For monitoring, no preparation is necessary.

The Test Sample

What is being tested?

Celiac disease is an autoimmune disorder characterized by an inappropriate immune response to gluten, a protein found in wheat, and related dietary proteins in rye and barley. Celiac disease tests are a group of assays developed to help diagnose and monitor the disease and a few other gluten-sensitive conditions. These tests detect autoantibodies that the body produces as part of the immune response. In the past, the only way to diagnose celiac disease was by examination of a tissue biopsy of the small intestine. While this microscopic evaluation is still considered the gold standard and is still used to confirm a diagnosis, the availability of less invasive blood tests to screen for celiac disease has reduced the number of biopsies needed. 

Celiac disease blood tests measure the amount of particular autoantibodies in the blood. Tests that detect the IgA class (Immunoglobulin A) and IgG class (Immunoglobulin G) of the autoantibodies are available, but the type that measure IgA are more specific and are used almost exclusively. IgG and IgA are two of five classes of antibody proteins that the immune system produces in response to a perceived threat. IgA is the primary antibody present in gastrointestinal secretions.

IgG autoantibody tests may be ordered if a person has a deficiency in IgA. This happens about 2-3% of the time in people with celiac disease and can lead to false-negative test results.

Common tests for celiac disease include:

  • IgA class of Anti-tissue Transglutaminase Antibody (anti-tTG): Tissue transglutaminase is an enzyme that causes the crosslinking of certain proteins. Anti-tTG, IgA is the most sensitive and specific blood test for celiac disease and is the single test preferred by the American College of Gastroenterology (ACG), according to its 2013 guidelines, for the detection of celiac disease in those over the age of 2 years. The IgG class of anti-tTG may be ordered as an alternative in those who have a deficiency of IgA. Although "tissue" is in the name of these tests, they are measured in the blood.
  • Quantitative immunoglobulin A (IgA): Used to determine if someone is deficient in the IgA class of antibodies and whether the IgG class of autoantibody tests should be performed.
  • Deamidated Gliadin Peptide (DGP) Antibodies, IgA: Anti-DGP test is a relatively new test that may be positive in some people with celiac disease who are anti-tTG negative, including children less than 2 years old. DGP IgG testing along with anti-tTG IgG is recommended by the ACG for those who have low IgA or IgA deficiency.

Other tests less commonly performed include:

  • Anti-Gliadin Antibodies (AGA), IgG and IgA classes: Gliadin is part of the gluten protein found in wheat (similar proteins are found in rye, barley, and oats). AGA is an autoantibody directed against the gliadin portion. The 2013 AGA guidelines do not recommend this test for the primary detection of celiac disease due to concerns with its accuracy.
  • Anti-Endomysial Antibodies (EMA), IgA class: Endomysium is the thin connective tissue layer that covers individual muscle fibers. Anti-Endomysial antibodies are developed in reaction to the ongoing damage to the intestinal lining. It has been found that tTg is the substance detected in this test. Almost 100% of patients with active celiac disease and 70% of patients with dermatitis herpetiformis (another gluten-sensitive condition that causes an itchy, burning, blistering rash on the skin) will have the IgA class of anti-EMA antibodies. The test is more difficult to do and interpret properly than anti-tTg. 
  • Anti-Reticulin Antibodies (ARA), IgA class: Anti-ARA is not as specific or sensitive as the other autoantibodies. It is found in about 60% of celiac disease patients and about 25% of patients with dermatitis herpetiformis.
  • Anti-Actin (F-actin), IgA class: The F-Actin antibody test may indicate increased intestinal damage.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm. 

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

Follow your doctor's instructions. For diagnosis, ingestion of gluten-containing foods for a time period, such as several weeks, is necessary. For monitoring, no preparation is necessary.

The Test

Common Questions

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

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