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Table of Contents
Self-Checks/At-Home Testing
Blood Tests
Imaging
Differential Diagnoses
Frequently Asked Questions
Next in Celiac Disease Guide
Diagnosingceliac diseaseis a fairly lengthy process. In most cases, you’ll first have blood tests done and then ultimately have a procedure known as an endoscopy, in which healthcare providers look directly at your small intestine.In the best-case scenario, you’ll have your answer within a few days or a week, but this can take much longer in some areas, especially where gastroenterologists are in short supply.
Here’s what you can expect as your healthcare provider works to determine if you have celiac disease, plus what you can do to help.
Tom Werner / Getty Images
Note, however, that going gluten-free can impact test results, so this must be considered when you are being evaluated. Mention your diet changes to your healthcare provider, as your healthcare provider may recommend you return to a regular diet before testing.
You can also considerat-home screening testsfor celiac disease, which you can purchase in some stores or online. These use a finger-prick blood sample that you send to a laboratory, and you receive the results in about a week.
Medical guidelines recommend celiac disease testing for relatives of those diagnosed with celiac disease since the condition runs in families. Familial risk is due to specific genes.
Some people take advantage ofconsumer genetic testing, such as through 23andMe, to screen for celiac-related genes.This testing doesnotrequire being on a gluten-containing diet. Note, however, that it only shows a risk of the disease, rather than markers of having celiac disease.
Labs and Tests
These tests look for various antibodies.If your body is undergoing an autoimmune reaction to gluten, one or more of these blood tests should come up positive. This indicates that further testing is needed to see if you truly have celiac disease.
However, it is possible for you to have negative blood test results and still have celiac disease. Some people have a condition known asIgA deficiencythat can cause false-negative results on some celiac disease blood tests. If you have this (there’s yet another blood test that will look for it), you’ll need different tests to screen for celiac disease.In a few other cases, the blood test results simply don’t reflect the amount of intestinal damage present.
Therefore, if your blood tests are negative, but your symptoms and family medical history still indicate a strong possibility of celiac disease, you should talk to your healthcare provider about further testing.
Diet and Your Test ResultsBecause the tests for celiac disease are looking specifically for signs of small intestine damage,you must be eating gluten for the tests to be accurate. If you’re not eating gluten-containing foods—or not eating enough of them—it’s possible for the testing to come up negative, even if you actually do have celiac disease.It’s ideal to continue eating a normal diet, with gluten-containing foods several times a day, until all your testing is completed.
Diet and Your Test Results
Because the tests for celiac disease are looking specifically for signs of small intestine damage,you must be eating gluten for the tests to be accurate. If you’re not eating gluten-containing foods—or not eating enough of them—it’s possible for the testing to come up negative, even if you actually do have celiac disease.It’s ideal to continue eating a normal diet, with gluten-containing foods several times a day, until all your testing is completed.
Because the tests for celiac disease are looking specifically for signs of small intestine damage,you must be eating gluten for the tests to be accurate. If you’re not eating gluten-containing foods—or not eating enough of them—it’s possible for the testing to come up negative, even if you actually do have celiac disease.
It’s ideal to continue eating a normal diet, with gluten-containing foods several times a day, until all your testing is completed.
If you’ve already started following a gluten-free diet, you may want to consider what’s called agluten challenge, in which you eat a set amount of gluten for some period of time, and then undergo testing for celiac disease. This approach does carry some risks, though, and may not produce the results you want, so talk to your healthcare provider about the potential pros and cons.
Positive Blood Tests With Skin Rash
If you have an itchy, painful blistering skin rash calleddermatitis herpetiformis,pluspositive celiac blood tests, you’re officially diagnosed with celiac disease as well—no further testing required.
That said, a positive skin biopsyis the gold standard for confirmingdermatitis herpetiformis. This looks for deposits of anti-gluten antibodies under your skin. Your healthcare provider may or may not opt for this testing method.
Blood Tests for Celiac Disease
Genetic Testing
Genetic testscan’ttell you if you actually have celiac disease—for that, you’ll need to undergo the blood tests and endoscopy.If you don’t have one of these two main genes, the odds of you having celiac disease are very slim, although some cases of celiac have been documented in people who don’t carry either gene.
A positive genetic test for celiac disease doesn’t mean you definitely have celiac disease—up to 40% of the population carries one of those genes, and the vast majority never develop celiac.However, it does mean you possibly can develop the condition. You’ll need to discuss with your healthcare provider your next steps if your celiac disease gene test comes back positive, especially if you have a family history of celiac disease.
In an endoscopy, an instrument with a tiny camera attached is threaded down your throat so your healthcare provider can look directly at the lining of your small intestine to see ifvillous atrophyis present. In some cases (but not all), the damage from celiac disease can be seen immediately during this procedure.
Just as it’s possible to have negative blood tests but a biopsy that shows you have celiac disease, it’s also possible to have positive blood tests but a negative biopsy. This is known aslatent celiac diseaseorpotential celiac disease.
If you fall into this category, your healthcare provider likely will recommend regular repeat endoscopies, since many people with latent celiac disease ultimately develop full-blown intestinal damage. You also can discuss the possibility of following the gluten-free diet as a trial, to see if any symptoms clear up.
Endoscopy to Diagnose Celiac Disease
The combination of positive blood tests and an endoscopy finding of villous atrophy will help rule out other causes of villous atrophy, which include tropical sprue, severe intestinal bacterial overgrowth, eosinophilic enteritis, infectious enteritis, and lymphoma.
Some people who test negative for celiac disease nonetheless still have symptoms that clear up on a gluten-free diet. They may be diagnosed with non-celiacgluten sensitivity, a recently recognized and as-yet poorly understood condition. This is sometimes called gluten intolerance orgluten allergy(although it is not a true allergy). There areno generally accepted tests to determine if you have gluten sensitivity; the only way to know is to give up gluten and see if your symptoms improve.
5 Different Reactions to Gluten
If you test negative for celiac disease, that doesn’t mean you won’tdevelop it in the future. Close relatives of celiac disease patients (who themselves have a high risk of developing the condition) with a positive celiac antibody blood test may need repeated screening over the course of years to catch all cases.
Therefore, if you have risk factors for celiac disease—“celiac genes,” close family members with the condition, other autoimmune diseases, or even just related symptoms—you may want to consider setting up a regular testing schedule with your healthcare provider. If you are diagnosed with celiac disease early, you can minimize the damage to your body and potentially ward off complications, such asosteoporosisandmalnutrition.
A Word From Verywell
Positive test results for celiac disease on your endoscopy and biopsy mean you definitely have the condition and must follow the gluten-free diet for life. Although this can seem overwhelming at first, you ultimately may findyour health improves dramaticallyand that eating gluten-free becomes just another part of your way of life. Truthfully, there are many, many foods you can eat when you’re gluten-free.
Frequently Asked QuestionsAmong the various tests that can help to home in on a diagnosis of celiac disease, the one regarded as the gold standard is the tTG-IgA test. It looks for antibodies called tissue transglutaminase IgA in people who are eating gluten. For children 2 and under, testing for deamidated gliadin IgA should be included. The tTg-IgA test is positive in 98% of people who have celiac disease.The only way to tell for sure if a person has celiac disease is with an intestinal, or duodenal, biopsy. It involves threading a long, thin scope with a camera at the end down the throat to the small intestine. This provides a view of the cilia lining the small intestine and makes it possible to extract a small sample of tissue for examination in a lab. It usually is done on an outpatient basis.Pathologists who study duodenal samples for celiac disease use a system called Marsh classification to determine if a lab sample has histological changes that indicate celiac disease. The system is based on certain characteristics of the tissue to assign it a type between 0 and 4. If you have an intestinal biopsy that comes back as a type 3, you will be diagnosed with celiac disease.Typically, agastroenterologistwill diagnose celiac disease. These healthcare providers specialize in conditions that affect all organs of the digestive tract, including the small intestine, and are trained to do endoscopies.There is no routine screening for celiac disease, but certain people who potentially are at risk should be tested, according to the Celiac Disease Foundation:Children over 3 and adults withsymptomsof celiac diseaseFirst-degree relatives of people who have celiac diseasePeople with certain autoimmune disorders and other conditions that are strongly associated with celiac disease—type 1 diabetes, autoimmune liver disease,Down syndrome,Turner syndrome, Williams syndrome, and selective immunoglobulin A (IgA) deficiency
Among the various tests that can help to home in on a diagnosis of celiac disease, the one regarded as the gold standard is the tTG-IgA test. It looks for antibodies called tissue transglutaminase IgA in people who are eating gluten. For children 2 and under, testing for deamidated gliadin IgA should be included. The tTg-IgA test is positive in 98% of people who have celiac disease.
The only way to tell for sure if a person has celiac disease is with an intestinal, or duodenal, biopsy. It involves threading a long, thin scope with a camera at the end down the throat to the small intestine. This provides a view of the cilia lining the small intestine and makes it possible to extract a small sample of tissue for examination in a lab. It usually is done on an outpatient basis.
Pathologists who study duodenal samples for celiac disease use a system called Marsh classification to determine if a lab sample has histological changes that indicate celiac disease. The system is based on certain characteristics of the tissue to assign it a type between 0 and 4. If you have an intestinal biopsy that comes back as a type 3, you will be diagnosed with celiac disease.
Typically, agastroenterologistwill diagnose celiac disease. These healthcare providers specialize in conditions that affect all organs of the digestive tract, including the small intestine, and are trained to do endoscopies.
There is no routine screening for celiac disease, but certain people who potentially are at risk should be tested, according to the Celiac Disease Foundation:Children over 3 and adults withsymptomsof celiac diseaseFirst-degree relatives of people who have celiac diseasePeople with certain autoimmune disorders and other conditions that are strongly associated with celiac disease—type 1 diabetes, autoimmune liver disease,Down syndrome,Turner syndrome, Williams syndrome, and selective immunoglobulin A (IgA) deficiency
There is no routine screening for celiac disease, but certain people who potentially are at risk should be tested, according to the Celiac Disease Foundation:
How Celiac Disease Is Treated
12 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.Green PHR.The Role of Endoscopy in the Diagnosis of Celiac Disease.Gastroenterol Hepatol (N Y).2014;10(8):522-524.Rashid M, Butzner JD, Warren R, et al.Home blood testing for celiac disease: recommendations for management.Can Fam Physician.2009;55(2):151-3.Kalf RR, Mihaescu R, Kundu S, De knijff P, Green RC, Janssens AC.Variations in predicted risks in personal genome testing for common complex diseases.Genet Med.2014;16(1):85-91. doi:10.1038/gim.2013.80Wolf J, Hasenclever D, Petroff D, et al.Antibodies in the diagnosis of coeliac disease: a biopsy-controlled, international, multicentre study of 376 children with coeliac disease and 695 controls.PLoS ONE. 2014;9(5):e97853. doi:10.1371/journal.pone.0097853Antiga E, Caproni M.The diagnosis and treatment of dermatitis herpetiformis.Clin Cosmet Investig Dermatol.2015;8:257-65. doi:10.2147/CCID.S69127Zhu J, Mulder CJ, Dieleman LA.Celiac Disease: Against the Grain in Gastroenterology.Journal of the Canadian Association of Gastroenterology.2018. doi:10.1093/jcag/gwy042Roy A, Pallai M, Lebwohl B, Taylor AK, Green PH.Attitudes Toward Genetic Testing for Celiac Disease.J Genet Couns.2016;25(2):270-8. doi:10.1007/s10897-015-9867-zLuján-sanchis M, Pérez-cuadrado-robles E, García-lledó J, et al.Role of capsule endoscopy in suspected celiac disease: A European multi-centre study.World J Gastroenterol.2017;23(4):703-711. doi:10.3748/wjg.v23.i4.703Rubio-tapia A, Barton SH, Murray JA.Celiac disease and persistent symptoms.Clin Gastroenterol Hepatol.2011;9(1):13-7. doi:10.1016/j.cgh.2010.07.014Celiac Disease Foundation.Testing.Celiac Disease Foundation.Testing.Celiac Disease Foundation. Diagnosis.Why an Intestinal Biopsy?Additional ReadingNational Institute of Diabetes and Digestive and Kidney Diseases.Celiac Disease.University of Chicago Celiac Disease Center.Diagnosis of Celiac Disease.
12 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.Green PHR.The Role of Endoscopy in the Diagnosis of Celiac Disease.Gastroenterol Hepatol (N Y).2014;10(8):522-524.Rashid M, Butzner JD, Warren R, et al.Home blood testing for celiac disease: recommendations for management.Can Fam Physician.2009;55(2):151-3.Kalf RR, Mihaescu R, Kundu S, De knijff P, Green RC, Janssens AC.Variations in predicted risks in personal genome testing for common complex diseases.Genet Med.2014;16(1):85-91. doi:10.1038/gim.2013.80Wolf J, Hasenclever D, Petroff D, et al.Antibodies in the diagnosis of coeliac disease: a biopsy-controlled, international, multicentre study of 376 children with coeliac disease and 695 controls.PLoS ONE. 2014;9(5):e97853. doi:10.1371/journal.pone.0097853Antiga E, Caproni M.The diagnosis and treatment of dermatitis herpetiformis.Clin Cosmet Investig Dermatol.2015;8:257-65. doi:10.2147/CCID.S69127Zhu J, Mulder CJ, Dieleman LA.Celiac Disease: Against the Grain in Gastroenterology.Journal of the Canadian Association of Gastroenterology.2018. doi:10.1093/jcag/gwy042Roy A, Pallai M, Lebwohl B, Taylor AK, Green PH.Attitudes Toward Genetic Testing for Celiac Disease.J Genet Couns.2016;25(2):270-8. doi:10.1007/s10897-015-9867-zLuján-sanchis M, Pérez-cuadrado-robles E, García-lledó J, et al.Role of capsule endoscopy in suspected celiac disease: A European multi-centre study.World J Gastroenterol.2017;23(4):703-711. doi:10.3748/wjg.v23.i4.703Rubio-tapia A, Barton SH, Murray JA.Celiac disease and persistent symptoms.Clin Gastroenterol Hepatol.2011;9(1):13-7. doi:10.1016/j.cgh.2010.07.014Celiac Disease Foundation.Testing.Celiac Disease Foundation.Testing.Celiac Disease Foundation. Diagnosis.Why an Intestinal Biopsy?Additional ReadingNational Institute of Diabetes and Digestive and Kidney Diseases.Celiac Disease.University of Chicago Celiac Disease Center.Diagnosis of Celiac Disease.
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.
Green PHR.The Role of Endoscopy in the Diagnosis of Celiac Disease.Gastroenterol Hepatol (N Y).2014;10(8):522-524.Rashid M, Butzner JD, Warren R, et al.Home blood testing for celiac disease: recommendations for management.Can Fam Physician.2009;55(2):151-3.Kalf RR, Mihaescu R, Kundu S, De knijff P, Green RC, Janssens AC.Variations in predicted risks in personal genome testing for common complex diseases.Genet Med.2014;16(1):85-91. doi:10.1038/gim.2013.80Wolf J, Hasenclever D, Petroff D, et al.Antibodies in the diagnosis of coeliac disease: a biopsy-controlled, international, multicentre study of 376 children with coeliac disease and 695 controls.PLoS ONE. 2014;9(5):e97853. doi:10.1371/journal.pone.0097853Antiga E, Caproni M.The diagnosis and treatment of dermatitis herpetiformis.Clin Cosmet Investig Dermatol.2015;8:257-65. doi:10.2147/CCID.S69127Zhu J, Mulder CJ, Dieleman LA.Celiac Disease: Against the Grain in Gastroenterology.Journal of the Canadian Association of Gastroenterology.2018. doi:10.1093/jcag/gwy042Roy A, Pallai M, Lebwohl B, Taylor AK, Green PH.Attitudes Toward Genetic Testing for Celiac Disease.J Genet Couns.2016;25(2):270-8. doi:10.1007/s10897-015-9867-zLuján-sanchis M, Pérez-cuadrado-robles E, García-lledó J, et al.Role of capsule endoscopy in suspected celiac disease: A European multi-centre study.World J Gastroenterol.2017;23(4):703-711. doi:10.3748/wjg.v23.i4.703Rubio-tapia A, Barton SH, Murray JA.Celiac disease and persistent symptoms.Clin Gastroenterol Hepatol.2011;9(1):13-7. doi:10.1016/j.cgh.2010.07.014Celiac Disease Foundation.Testing.Celiac Disease Foundation.Testing.Celiac Disease Foundation. Diagnosis.Why an Intestinal Biopsy?
Green PHR.The Role of Endoscopy in the Diagnosis of Celiac Disease.Gastroenterol Hepatol (N Y).2014;10(8):522-524.
Rashid M, Butzner JD, Warren R, et al.Home blood testing for celiac disease: recommendations for management.Can Fam Physician.2009;55(2):151-3.
Kalf RR, Mihaescu R, Kundu S, De knijff P, Green RC, Janssens AC.Variations in predicted risks in personal genome testing for common complex diseases.Genet Med.2014;16(1):85-91. doi:10.1038/gim.2013.80
Wolf J, Hasenclever D, Petroff D, et al.Antibodies in the diagnosis of coeliac disease: a biopsy-controlled, international, multicentre study of 376 children with coeliac disease and 695 controls.PLoS ONE. 2014;9(5):e97853. doi:10.1371/journal.pone.0097853
Antiga E, Caproni M.The diagnosis and treatment of dermatitis herpetiformis.Clin Cosmet Investig Dermatol.2015;8:257-65. doi:10.2147/CCID.S69127
Zhu J, Mulder CJ, Dieleman LA.Celiac Disease: Against the Grain in Gastroenterology.Journal of the Canadian Association of Gastroenterology.2018. doi:10.1093/jcag/gwy042
Roy A, Pallai M, Lebwohl B, Taylor AK, Green PH.Attitudes Toward Genetic Testing for Celiac Disease.J Genet Couns.2016;25(2):270-8. doi:10.1007/s10897-015-9867-z
Luján-sanchis M, Pérez-cuadrado-robles E, García-lledó J, et al.Role of capsule endoscopy in suspected celiac disease: A European multi-centre study.World J Gastroenterol.2017;23(4):703-711. doi:10.3748/wjg.v23.i4.703
Rubio-tapia A, Barton SH, Murray JA.Celiac disease and persistent symptoms.Clin Gastroenterol Hepatol.2011;9(1):13-7. doi:10.1016/j.cgh.2010.07.014
Celiac Disease Foundation.Testing.
Celiac Disease Foundation. Diagnosis.Why an Intestinal Biopsy?
National Institute of Diabetes and Digestive and Kidney Diseases.Celiac Disease.University of Chicago Celiac Disease Center.Diagnosis of Celiac Disease.
National Institute of Diabetes and Digestive and Kidney Diseases.Celiac Disease.
University of Chicago Celiac Disease Center.Diagnosis of Celiac Disease.
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