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What is the best way to find out if you have celiac?

Dr. Cynthia Rudert, Celiac Disease and Gluten Intolerance expert answers your questions on celiac:

What is the best test to find out if you have celiac?

Dr. Rudert answers:

The "Gold Standard" to diagnose celiac disease is the small bowel biopsy. Celiac disease, at this point in time, requires biopsy confirmation. Small bowel biopsies are obtained endoscopically and the gastroenterologist should obtain at least 6 specimens. This requirement is already changing for children. If they have high enough levels of TTG (tissue transglutaminase) and are EMA positive and have 1 one or both celiac genes they no longer need small bowel biopsies. For children that meet this criterion biopsies are no longer recommended. I hope soon that the same will be true for adults since endoscopy is invasive and expensive!

If someone went gluten free how could they be diagnosed with celiac?

Dr. Rudert answers:

This is indeed a very common question in my practice. Unfortunately, by the time most patients see me they have been to multiple health care facilities and providers, sometimes dozens! Many people finally google their symptoms or a friend tells them to go gluten free. I am very reluctant, with a few exceptions, to recommend a gluten challenge. This is because many people can become very ill when gluten is reintroduced back in to their diet.

What is a gluten challenge?

Dr. Rudert answers:

A gluten challenge is when you tell people on a gluten free diet to eat wheat for a period of time before you test them.

Why would anyone recommend a gluten challenge?

Dr. Rudert answers:

A gluten challenge may be recommended because celiac blood testing becomes normal the longer someone is gluten free. In select situations celiac genetic testing is beneficial since if you are negative for both of the celiac genes (HLA DQ 2 and HLA DQ8) you don't have celiac. Genetic testing is not affected by diet.

Is the blood test for celiac a reliable test?

Dr. Rudert answers:

Celiac blood testing like most blood tests is not 100% reliable. Be very careful if a healthcare provider tells you that you do not have celiac based on results of serology since 10% of celiacs actually can have negative serology. Since I evaluate thousands of patients who have seen other providers I have seen many celiac blood panels that are incomplete. There are however certain tests within the panel that are extremely specific. If you are EMA (anti-endomysial antibody) positive you definitely have celiac.

Why can't doctors tell the difference between IBS and celiac?

Dr. Rudert answers:

Under what I call the "IBS umbrella" is a wide variety of diagnostic possibilities. Every day I see individuals with this diagnosis and usually other explanations can be found. This requires time and a very thorough history. In my opinion probably at least 10% of IBS patients may have celiac and more might have gluten sensitivity. There are also about 20 other causes I look for when doing evaluations. Blood testing for celiac has it’s limitations since one needs to be eating gluten for the test to be of benefit. Remember 10% of celiacs are seronegative. I seldomly recommend a gluten challenge except in rare situations.

Thank you for stopping by Dr. Rudert's Celiac Blog!

Please stop by again soon! Dr. Cynthia Rudert will be answering more of the most frequently asked celiac questions every week!

Dr. Cynthia Rudert has a private practice specializing in Celiac Disease and Gluten Intolerance in Atlanta, Georgia. Dr. Rudert is also a popular speaker on Celiac Disease and Gluten Intolerance for organizations, medical professionals, and the public.

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