Other blood tests look for different indicators, including fatty acid-binding protein (I-FABP) and certain genetic markers.
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When a celiac blood test is positive, further testing is necessary. The only way to definitively diagnose celiac disease is with abiopsyof the small intestine to look for damage to the tissue.
This article reviews tests done for celiac disease screening and what they reveal.
Antibody Tests
There are four antibody tests for celiac disease. The most sensitive screen for immunoglobulin A (IgA)—the antibody most prominent in celiac.
People who areIgA-deficient(notably those with autoimmune disorders such aslupusorrheumatoid arthritismay be tested for immunoglobulin G (IgG) rather than IgA.
In order for an antibody blood test for celiac disease to be accurate, the person being screened must be eating gluten at the time of testing.
Tissue Transglutaminase (tTG)
The tTG test, also known as the anti-tissue transglutaminase test or anti-tTG, is the first-line option for antibody testing. tTG is an enzyme that plays a role in wound healing, cell-to-cell adhesion, the regulation of cell survival and death, and other biological processes.
The interaction between tTG and gliadins is complex. After tTG breaks down gluten, the subsequent breakdown of gliadins in the bloodstream will activate tTG in the small intestine, causing enzyme levels to increase.
Deamidated Gliadin Peptide (DGP)
Deamidated gliadin is produced when tTG breaks down gliadin in the digestive tract.In people with celiac disease, this response is amplified and provides a key marker for the disease.
The deamidated gliadin peptide (DGP) test is able to detect deamidated gliadin IgA with a specificity of 94%, but a less-than-ideal sensitivity of 74%.
Because of this, it is most often used in tandem with the tTG test to provide early evidence of celiac disease, especially in children age 2 and under whose immune systems are not fully developed.
Endomysial Antibody (EMA)
Endomysial antibodies are produced in a layer of tissue surrounding muscles called the endomysium which contains a form of tTG that, when exposed to gluten, will activate and churn out antibodies in an autoimmune response.
The endomysial antibody (EMA) test is considerably more accurate than either the tTG or DGP test.It’s also more complicated and expensive.
Because the antibodies bind with smooth muscles, frozen esophageal or umbilical cord tissue is needed to draw the antibodies from the blood sample in high enough concentrations to elicit an accurate result.
The EMA test is primarily used to detect IgA antibodies, although an IgG version is also available.
The EMA test is most often used in people withclassic celiac disease symptomswho have tested negative on less costly tTG and DGP tests.Celiac blood test results are usually returned within one to three days, but the EMA and celiac genetic test results may take longer.
The EMA test is most often used in people withclassic celiac disease symptomswho have tested negative on less costly tTG and DGP tests.
Celiac blood test results are usually returned within one to three days, but the EMA and celiac genetic test results may take longer.
Total Serum IgA
The total serum IgA test is used to check for IgA deficiency, which can cause a false-negative tTG-IgA or EMA reading. It is often used when a person tests negative for one or both of these tests.
At other times, it is performed alongside the tTG to establish whether there is some degree of IgA deficiency that might otherwise influence the results.
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Other Blood Tests
Besides the antibody-based tests for celiac disease, there are two other blood tests that may be done before an intestinal biopsy is considered.
Intestinal Fatty Acid-Binding Protein (I-FABP)
The I-FABP test detects a protein that is released into the blood whenever the intestines are damaged, as is characteristic of celiac disease.
Elevations of I-FAGP in blood may be evidence of celiac disease even if antibody tests are inconclusive. Urine samples can also be tested for I-FABP.
Celiac Genetic Testing
Celiac genetic testing, also known as HLA typing, is able to detect gene complexes called human leukocyte antigens (HLA) that may predispose a person to celiac disease, namely HLA-DQ2 and HLA-DQ8.
Apositive genetic test resultdoes not mean that you have celiac disease, since 55% of the general population have HLA-DQ2 and HLA-DQ8 compared to 98% of the celiac populationBut it can exclude celiac disease as a cause if neither of the antigens is detected.
What to Expect During an Endoscopy for Celiac Disease
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Elli L, Branchi F, Tomba C, et al.Diagnosis of gluten-related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity.World J Gastroenterol. 2015;21(23):7110-9. doi:10.3748/wjg.v21.i23.7110Oxentenko AS, Murray JA.Celiac disease: Ten things that every gastroenterologist should know.Clin Gastroenterol Hepatol. 2015;13(8):1396-404. doi:10.1016/j.cgh.2014.07.024Pallav K, Xu H, Leffler DA, Kabbani T, Kelly CP.Immunoglobulin A deficiency in celiac disease in the United States.J Gastroenterol Hepatol.2016;31(1):133-7. doi:10.1111/jgh.13176Ontiveros N, Hardy MY, Cabrera-Chavez F.Assessing of celiac disease and nonceliac gluten sensitivity.Gastroenterol Res Pract. 2015;2015:723954. doi:10.1155/2015/723954Caio G, Volta U, Sapone A, et al.Celiac disease: a comprehensive current review.BMC Med. 2019;17(1):142. doi:10.1186/s12916-019-1380-zScanlon SA, Murray JA.Update on celiac disease - etiology, differential diagnosis, drug targets, and management advances.Clin Exp Gastroenterol. 2011;4:297–311. doi:10.2147/CEG.S8315Agency for Healthcare Research and Quality.Diagnosis of celiac disease: current state of the evidence.Silvester JA, Kurada S, Szwajcer A, Kelly CP, Leffler DA, Duerksen DR.Tests for serum transglutaminase and endomysial antibodies do not detect most patients with celiac disease and persistent villous atrophy on gluten-free diets: a meta-analysis.Gastroenterology. 2017;153(3):689-701.e1. doi:10.1053/j.gastro.2017.05.015Oldenburger IB, Wolters VM, Kardol-Hoefnagel T, Houwen RHJ, Otten HG.Serum intestinal fatty acid-binding protein in the noninvasive diagnosis of celiac disease.APMIS.2018;126(3):186-90. doi:10.1111/apm.12800Pallav K, Kabbani T, Tariq S, Vanga R, Kelly CP, Leffler DA.Clinical utility of celiac disease-associated HLA testing.Dig Dis Sci. 2014;59(9):2199-206. doi:10.1007/s10620-014-3143-1Cecilio LA, Bonatto MW.The prevalence of HLA DQ2 and DQ8 in patients with celiac disease, in family and in general population.Arq Bras Cir Dig. 2015;28(3):183-5. doi:10.1590/S0102-67202015000300009
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Elli L, Branchi F, Tomba C, et al.Diagnosis of gluten-related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity.World J Gastroenterol. 2015;21(23):7110-9. doi:10.3748/wjg.v21.i23.7110Oxentenko AS, Murray JA.Celiac disease: Ten things that every gastroenterologist should know.Clin Gastroenterol Hepatol. 2015;13(8):1396-404. doi:10.1016/j.cgh.2014.07.024Pallav K, Xu H, Leffler DA, Kabbani T, Kelly CP.Immunoglobulin A deficiency in celiac disease in the United States.J Gastroenterol Hepatol.2016;31(1):133-7. doi:10.1111/jgh.13176Ontiveros N, Hardy MY, Cabrera-Chavez F.Assessing of celiac disease and nonceliac gluten sensitivity.Gastroenterol Res Pract. 2015;2015:723954. doi:10.1155/2015/723954Caio G, Volta U, Sapone A, et al.Celiac disease: a comprehensive current review.BMC Med. 2019;17(1):142. doi:10.1186/s12916-019-1380-zScanlon SA, Murray JA.Update on celiac disease - etiology, differential diagnosis, drug targets, and management advances.Clin Exp Gastroenterol. 2011;4:297–311. doi:10.2147/CEG.S8315Agency for Healthcare Research and Quality.Diagnosis of celiac disease: current state of the evidence.Silvester JA, Kurada S, Szwajcer A, Kelly CP, Leffler DA, Duerksen DR.Tests for serum transglutaminase and endomysial antibodies do not detect most patients with celiac disease and persistent villous atrophy on gluten-free diets: a meta-analysis.Gastroenterology. 2017;153(3):689-701.e1. doi:10.1053/j.gastro.2017.05.015Oldenburger IB, Wolters VM, Kardol-Hoefnagel T, Houwen RHJ, Otten HG.Serum intestinal fatty acid-binding protein in the noninvasive diagnosis of celiac disease.APMIS.2018;126(3):186-90. doi:10.1111/apm.12800Pallav K, Kabbani T, Tariq S, Vanga R, Kelly CP, Leffler DA.Clinical utility of celiac disease-associated HLA testing.Dig Dis Sci. 2014;59(9):2199-206. doi:10.1007/s10620-014-3143-1Cecilio LA, Bonatto MW.The prevalence of HLA DQ2 and DQ8 in patients with celiac disease, in family and in general population.Arq Bras Cir Dig. 2015;28(3):183-5. doi:10.1590/S0102-67202015000300009
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Elli L, Branchi F, Tomba C, et al.Diagnosis of gluten-related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity.World J Gastroenterol. 2015;21(23):7110-9. doi:10.3748/wjg.v21.i23.7110Oxentenko AS, Murray JA.Celiac disease: Ten things that every gastroenterologist should know.Clin Gastroenterol Hepatol. 2015;13(8):1396-404. doi:10.1016/j.cgh.2014.07.024Pallav K, Xu H, Leffler DA, Kabbani T, Kelly CP.Immunoglobulin A deficiency in celiac disease in the United States.J Gastroenterol Hepatol.2016;31(1):133-7. doi:10.1111/jgh.13176Ontiveros N, Hardy MY, Cabrera-Chavez F.Assessing of celiac disease and nonceliac gluten sensitivity.Gastroenterol Res Pract. 2015;2015:723954. doi:10.1155/2015/723954Caio G, Volta U, Sapone A, et al.Celiac disease: a comprehensive current review.BMC Med. 2019;17(1):142. doi:10.1186/s12916-019-1380-zScanlon SA, Murray JA.Update on celiac disease - etiology, differential diagnosis, drug targets, and management advances.Clin Exp Gastroenterol. 2011;4:297–311. doi:10.2147/CEG.S8315Agency for Healthcare Research and Quality.Diagnosis of celiac disease: current state of the evidence.Silvester JA, Kurada S, Szwajcer A, Kelly CP, Leffler DA, Duerksen DR.Tests for serum transglutaminase and endomysial antibodies do not detect most patients with celiac disease and persistent villous atrophy on gluten-free diets: a meta-analysis.Gastroenterology. 2017;153(3):689-701.e1. doi:10.1053/j.gastro.2017.05.015Oldenburger IB, Wolters VM, Kardol-Hoefnagel T, Houwen RHJ, Otten HG.Serum intestinal fatty acid-binding protein in the noninvasive diagnosis of celiac disease.APMIS.2018;126(3):186-90. doi:10.1111/apm.12800Pallav K, Kabbani T, Tariq S, Vanga R, Kelly CP, Leffler DA.Clinical utility of celiac disease-associated HLA testing.Dig Dis Sci. 2014;59(9):2199-206. doi:10.1007/s10620-014-3143-1Cecilio LA, Bonatto MW.The prevalence of HLA DQ2 and DQ8 in patients with celiac disease, in family and in general population.Arq Bras Cir Dig. 2015;28(3):183-5. doi:10.1590/S0102-67202015000300009
Elli L, Branchi F, Tomba C, et al.Diagnosis of gluten-related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity.World J Gastroenterol. 2015;21(23):7110-9. doi:10.3748/wjg.v21.i23.7110
Oxentenko AS, Murray JA.Celiac disease: Ten things that every gastroenterologist should know.Clin Gastroenterol Hepatol. 2015;13(8):1396-404. doi:10.1016/j.cgh.2014.07.024
Pallav K, Xu H, Leffler DA, Kabbani T, Kelly CP.Immunoglobulin A deficiency in celiac disease in the United States.J Gastroenterol Hepatol.2016;31(1):133-7. doi:10.1111/jgh.13176
Ontiveros N, Hardy MY, Cabrera-Chavez F.Assessing of celiac disease and nonceliac gluten sensitivity.Gastroenterol Res Pract. 2015;2015:723954. doi:10.1155/2015/723954
Caio G, Volta U, Sapone A, et al.Celiac disease: a comprehensive current review.BMC Med. 2019;17(1):142. doi:10.1186/s12916-019-1380-z
Scanlon SA, Murray JA.Update on celiac disease - etiology, differential diagnosis, drug targets, and management advances.Clin Exp Gastroenterol. 2011;4:297–311. doi:10.2147/CEG.S8315
Agency for Healthcare Research and Quality.Diagnosis of celiac disease: current state of the evidence.
Silvester JA, Kurada S, Szwajcer A, Kelly CP, Leffler DA, Duerksen DR.Tests for serum transglutaminase and endomysial antibodies do not detect most patients with celiac disease and persistent villous atrophy on gluten-free diets: a meta-analysis.Gastroenterology. 2017;153(3):689-701.e1. doi:10.1053/j.gastro.2017.05.015
Oldenburger IB, Wolters VM, Kardol-Hoefnagel T, Houwen RHJ, Otten HG.Serum intestinal fatty acid-binding protein in the noninvasive diagnosis of celiac disease.APMIS.2018;126(3):186-90. doi:10.1111/apm.12800
Pallav K, Kabbani T, Tariq S, Vanga R, Kelly CP, Leffler DA.Clinical utility of celiac disease-associated HLA testing.Dig Dis Sci. 2014;59(9):2199-206. doi:10.1007/s10620-014-3143-1
Cecilio LA, Bonatto MW.The prevalence of HLA DQ2 and DQ8 in patients with celiac disease, in family and in general population.Arq Bras Cir Dig. 2015;28(3):183-5. doi:10.1590/S0102-67202015000300009
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