While many people may consider going gluten-free for myriad health reasons, those who have celiac disease really have no choice in the matter. Those who have celiac disease have an autoimmune disorder and a severe allergy to gluten, which is a protein found in wheat, barley, and rye. It can sometimes be tough to avoid because gluten is quite insidious—meaning it’s found in many everyday foods like bread and pasta. Getting scientific tests performed if celiac disease is suspected is important so that doctors can move forward with treatment. Read on to learn more about celiac disease, the different types of celiac disease testing, and what treatment options are available.
Symptoms of Celiac Disease
Many people don’t know at first that they have celiac disease, and this is especially true in milder cases. However, celiac disease triggers an immune response in the small intestine. Over time, if this response isn’t dealt with appropriately, then damage can occur. Not only can the lining of the small intestine be damaged, but malabsorption can also occur. This is harmful at any age, but especially in children, as younger bodies need vitamins and minerals in which to grow. Symptoms of celiac disease can vary among age groups, and can easily mimic other gastrointestinal symptoms, disturbances, and upset. This is why it’s important to check in with your doctor if you’re having persistent GI symptoms over time. Some of the more prevalent symptoms of celiac disease include:
- Unexplained fatigue
- Weight loss
- Diarrhea or constipation (although not at the same time)
- Nausea and vomiting
- Abdominal pain
- Gas and bloating
Children may experience more digestive symptoms than adults, and in addition to the signs listed above, may experience foul-smelling stools or a swollen belly.
There are other symptoms in adults to watch out for as well, particularly because an adult patient with celiac disease likely had it as a child, and celiac disease has caused other medical conditions, such as anemia (failure to thrive in young children), joint pain, nervous system problems, loss of bone density (osteoporosis) or softening of bone (osteomalacia), blisters, and itchy skin.
If celiac disease is suspected, it’s imperative to get tested at any age, but it’s best to get on a gluten-free diet as soon as possible to prevent damage.
Who Should Be Screened?
If celiac disease is suspected, then any patient over the age of three should be tested as soon as possible to either rule out celiac disease or obtain the diagnosis. Also, those who are first-degree relatives of patients with celiac disease should also be tested, even if no symptoms are present. In some patients, symptoms can be mild or dormant, but damage can still occur. Also, because celiac disease is an autoimmune disease, those with certain medical conditions should be tested. This includes type 1 diabetes, autoimmune liver or thyroid disease, Turner syndrome, Down syndrome, and those with selective immunoglobulin A (IgA) deficiency.
Children under the age of three can also be tested if celiac disease is suspected, but doctors typically like to see a solid history of wheat, barley, or rye consumption to make sure that testing for celiac disease makes sense. However, a child who was started on solids at a relatively early age (like six months) could easily be a candidate.
Which Blood Tests Are Performed When Testing Celiac Disease?
Several different blood tests can be ordered to receive a clear-cut diagnosis of celiac disease. It is important to note that a patient should not begin a gluten-free diet before testing is completed. It is acceptable for patients to try a gluten challenge, such as eliminating gluten from the diet from a short period of time to ascertain if gluten is triggering an autoimmune response, but patients should not prescribe themselves a completely gluten-free diet prior to testing, as it can throw off the test results.
Patients and their doctors can opt for serology testing or genetic testing, both of which are completed by a blood draw. Serology testing looks for antibody proteins in the blood that indicate the autoimmune response to gluten, while celiac disease gene testing looks for specific genes, HLA-DQ2 and HLA-DQ8, which are both leukocyte antigens. The serology test looks for the Tissue Transglutaminase IgA antibody or tTG-IgA test. The tTG test is the most common test for celiac disease; however, it still runs the risk of giving a false positive. If there is a positive result for either the tTG or genetic testing, the doctor will order more invasive tests to determine if there truly is celiac disease.
Other Possible Gene Tests
There are other blood tests that the doctor may order instead, some of which include:
- Total serum IgA. This test checks for IgA deficiency.
- IgA Endomysial antibody (EMA). A similar antibody test. This test is actually more accurate but is not as widely used (and still typically requires follow-up endoscopy of some type).
- Intestinal fatty acid-binding protein (I-FABP). This test can show potential celiac disease by checking for this protein in the blood.
- Deamidated gliadin peptide (DGP IgA and IgG). A more concise IgA test; however, a positive result from this test may indicate other problems such as common variable immunodeficiency (CVID), so more workup is needed.
Follow-Up, Diagnosis, and Treatment
If either your tTG test or genetic test indicates that you may have celiac disease, likely your doctor will go beyond blood tests to ensure that the diagnosis is correct. An endoscopy is a surgical procedure where a long tube with a tiny camera on the end of it is inserted into the throat. With the camera, the doctor can get a decisive look at the small intestine to see if the villi (lining) is damaged, something that would certainly indicate celiac disease. Also, a small biopsy will be taken and analyzed to be completely sure.
Another option is to have a capsule endoscopy, which is slightly less invasive. In this procedure, the patient swallows a capsule that has a small camera inside of it. The camera will travel through the digestive tract, taking numerous pictures as it goes, to show indications of any damage. The only downside with this procedure is that a biopsy cannot be taken.
If a patient has blisters or itchy skin, a doctor may want a sample of the skin to look for dermatitis herpetiformis, which is a common resulting condition of having celiac disease.
If celiac disease is confirmed with these tests, the course of treatment is an immediate switch to a gluten-free diet. Gluten is commonly found in bulgur, semolina, barley, graham flour, malt, rye, farina, and durum, among other food products. Gluten can also be in some things you may not even consider, such as:
- Envelope glue
- Over-the-counter medications, vitamins, and supplements
- Toothpaste and mouthwash
- Communion wafers
- Modified food starch
Those who are extremely sensitive may want to take great care before ingesting or using some of these items. Doctors will often refer patients to see a knowledgeable nutritionist to get on a gluten-free path.
Your doctor may also prescribe other treatments as needed for conditions caused by celiac disease, such as medication for dermatitis herpetiformis, or digestive medications for GI or intestinal upset. However, there is no “medicine” or cure for celiac disease, and it is managed solely by diet. It is imperative to check up with your doctor every few months to make sure the diet is working and to talk about any other problems you may be experiencing.
If you need more information on celiac disease or suspect you may be suffering from this condition, contact GI Associates & Endoscopy Center today to request an appointment. We offer three convenient locations as well as specialized pediatric services.