A New Testing Algorithm for the Diagnosis of Celiac Disease

James March Mistler

doi:10.29074/ascls.28.4.212

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James March Mistler, MS, MLS (ASCP)^CM⇑
1. Department of Medical Laboratory Science, University of Massachusetts Dartmouth, North Dartmouth, MA

Address for Correspondence: James March Mistler, MS, MLS (ASCP)^CM, Department of Medical Laboratory Science, University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, MA 02747, 508-999-8944, jmarchmistler{at}umassd.edu

Abstract

The clinical investigation of patients with potential Celiac disease currently encompasses a large differential diagnosis including food allergies, medications, bacterial, viral and parasitic infection, AIDS, and Crohn's disease. The large diagnostic selection, coupled with a vast array of serological markers as well the self-treatment of patients makes diagnosing Celiac disease difficult. A newer marker, anti-deamidated gliadin peptide, should be paired with both the total serum IgA and anti-tissue transglutaminase IgA and IgG for screening symptomatic patients on a gluten diet for best diagnosis. Those patients that test positive by deamidated gliadin peptide and/or anti-tissue transglutaminase should then be confirmed with HLA typing and/or biopsy and started on a gluten-free diet sooner, reducing the destructive effects gluten can do on the intestine.

ABBREVIATIONS: CD - celiac disease, GFD - gluten free diet, AGA - anti-gliadin antibodies, TTG - anti-tissue transglutaminase antibodies, EMA - anti-endomysial antibodies, ARA - anti-reticulin antibodies, DGP - anti-deamidated gliadin peptide antibodies, IEL - intraepithelial lymphocytes, GALT - gut-associated lymphoid tissue, EATL - enteropathy-associated T-cell lymphoma.