Updates on Advances in Celiac Disease Screening

What is Celiac Disease?

The standard methods to diagnosis celiac disease involves lab testing with confirmation from an intestinal biopsy. There has been some debate as to whether celiac disease can be diagnosed based on the blood test alone.

What does the research say?

A 2012 study published by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) proposed possible criteria based on lab markers to reduce the need for biopsy confirmation in the diagnosis of celiac disease in children who are genetically predisposed to celiac disease.

It is still up for debate if this study on children can be equated in adults who are predisposed to celiac.

At this year’s Digestive Disease Week, an abstract was presented that explored the criteria in an adult population. The prospective cohort study consisted of 199 symptomatic patients with elevated anti-tTG titers (celiac lab markers). Of these patients, they had intestinal biopsy which showed that more than half of the cohort had “total villous atrophy.” Which is the gold standard for diagnosis of celiac disease. Still more ongoing research is being done to see if an intestinal biopsy is necessary for diagnosis of celiac or if diagnosis can be made based on lab testing.

If a person is already on a gluten-free diet, how do you test them for celiac?

Lab testing for celiac while on a gluten-free diet in most cases will have negative results. These patients should then test for the genetic markers: HLA DQ2/DQ8. People who are positive for both genetic markers but have negative celiac labs should undergo the intestinal biopsy for diagnosis.

Current recommendations are for those on a gluten-free diet to undergo a gluten challenge. However, most people elect not to challenge gluten. In those cases, it is recommended to treat them in a similar way to those with known celiac disease and proceed to the intestinal biopsy to confirm diagnosis, especially in moderate- to high-risk patients.

If you have a family history of celiac disease or have questions about getting tested. Please contact Dr. Heintze at (425) 686-4498 to schedule a medical consultation.

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Dr. Ellie Heintze, ND, LAc, is a naturopathic doctor and acupuncturist in Bothell, WA at her practice Starting Point Acupuncture. She is a pain specialist, seeing people who suffer from chronic pain, migraines, as well as digestive issues. Offering pain relief injections, acupuncture, facial rejuvenation, and nutrition consults. Most insurances accepted. Dr. Ellie Heintze is also the author of the book, A Starting Point Guide to Going Gluten-Free on Amazon.

Sources:

Advances in Diagnoses and Treatment Options for Celiac Disease, IBS, IBD, and EoE. Medscape. Nov 06, 2015.

Husby S, Koletzko S, Korponay-Szabó IR, et al; ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54:136-160.

Efthymakis K, Milano A, Laterza F, Serio M, Neri M. Anti-tissue transglutaminase autoantibody levels predict histology in celiac disease: a prospective application of the ESPGHAN guidelines in a symptomatic adult population. Program and abstracts of Digestive Disease Week; May 16-19, 2015; Washington, DC. Abstract 850.

Rubio-Tapia, A., et al. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108(5):656.