“How can celiac disease be diagnosed?”

Celiac disease affects approximately 1% of the population and can be diagnosed with a combination of specific blood tests as well as an endoscopy with a biopsy of the small intestine. It is extremely important and necessary that the patient be eating gluten at the time of the test in order for the results to be accurate. Symptoms of celiac disease vary but can include chronic abdominal pain, diarrhea, vitamin deficiencies, weight loss and failure to thrive in children.

He needs blood test for total IgA and TTG IgA. Sounds like he has a wheat allergy

The diagnosis is suspected by history and the diagnosis made by blood tests and endoscopy with biopsies from the small intestine. Most common symptoms include bloating, abdominal pain/cramping and loose stools

I will answer your questions in reverse order.

Celiac is diagnosed in two steps, usually. First, a blood test is done for antibodies, either TTG or Endomysial antibody. If one of these is positive, then the next step is a biopsy of the duodenum, which should confirm the diagnosis. One should be on gluten while this testing is done. If a patient is on gluten free diet then the tests could be falsely negative.

The most common symptom of celiac disease is nothing...no symptoms. Most people have silent disease - it show up only on some lab abnormalities such as elevated liver tests or anemia. If symptoms occur then they are protean - can be diarrhea, bloating, abdominal discomfort, cloudy headed feeling, a specific type of rash called dermatitis herpetiformis, or other vague symptoms.

You son's symptoms are more compatible with a true wheat allergy more than celiac disease. Currently, the medical community recognizes three possible conditions related to wheat ingestion:

1. Wheat allergy
2. Celiac disease
3. Non-celiac gluten sensitivity (this condition is still a bit mysterious and not fully understood)

An allergist would be best to confirm wheat allergy. A gastroenterologist is best to confirm or rule out celiac or NCGS.

Hope this helps.

Blood tests, small bowel bx, or trial of a gluten-free diet.

With specific regard to your question of how can celiac disease be diagnosed, in particular because of your son's reaction to when he eats bread, there are a number of ways this can be done. There are some blood tests that can be performed initially and if positive, then you have the diagnosis. If the blood tests are negative, then it may be necessary to consider an endoscopy with a biopsy of the small bowel and intestinal lining to confirm the diagnosis.

Mark Noar

Hello,

Blood tests are probably the easiest way. Certain labs such as tissuetransglutaminase antibodies, endomysial antobodies and gliadin antibodies can be ordered by a physician.

Skin rash with blisters and itching that is usually bilateral, known as Dermatitis Herpetiformis is sometimes associated with celiac disease. Although less common in Pediatric population.
The symptoms of celiac disease include diarrhea, abdominal bloating, gassiness, constipation, poor weight gain, weight loss, nausea, abdominal pain, dermatitis herpetiformis, bone pain, joint pain, short stature, weakness, tiredness, seizure, numbness, headache, infertility.
Celiac disease can be confirmed by a Pediatric gastroenterologist with upper gastrointestinal endoscopy with biopsies (tissues) taken from the surface of the small intestinal lining showing damage to the lining (villi) after the screening blood test showed elevated anti-tissue transglutaminase antibody (TTG).
The skin rash of dermatitis Herpetiformis is diagnosed by a dermatologist with skin biopsies (tissues) of the rash showing the typical damage of inflammatory cells and deposition of IgA.

These may be symptoms of celiac disease. Celiac disease can be diagnosed using blood tests, and confirmed with upper GI endoscopy and biopsies.

In the absence of diarrhea, abdominal pain, bloating, or weight loss, it is hard to tell. Rash by itself in association with wheat consumption is not diagnostic of celiac disease. Rash associated with certain food consumption could be related to gluten or wheat allergy. Celiac disease can be diagnosed by obtaining celiac serologic markers and upper endoscopy with biopsies. The serologic markers can be ordered by the primary care physician. The upper endoscopy with biopsies can be performed by pediatric gastroenterologist.

Celiac disease is a unique process when an allergic reaction triggers an immune attack on the lining of the bowel. Although there is a specific rash that can be seen with it, this is usually not immediately. Individuals can also have a normal allergic reaction to wheat products that is not celiac disease. That type of reaction may be testable with standard allergy testing. Celiac disease is interesting because it has multiple presentations. The classic is bloating, diarrhea and poor weight gain. Sometimes, it is just poor weight gain. Celiac disease can be screened for with a very good blood test. However, the blood test is not perfect and confirmation requires a upper endoscopy and a biopsy of the small intestine lining.

Mark R. Corkins, M.D.