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How is celiac disease diagnosed?
The diagnosis of celiac disease is often delayed and it may take several
months or years for the patient and the health care professional to think of it as
the cause of many non-specific symptoms. History and physical examination may
give direction as to the diagnosis, but commonly it take many visits with the
patient complaining of recurrent abdominal pain, non-specific joint aches, or
chronic anemia that does not respond to iron treatment, to raise
the suspicion that celiac disease is a possibility.
When the diagnosis is suspected, there is a two-step screening process to
make the diagnosis:
Blood test for immunoglobulin A
anti-tissue transglutaminase antibody (IgA TTG). Testing for antiendomysial
antibody may also be considered.
If the screening blood test is
positive, then endoscopy and biopsy of the lining of the duodenum (the first
part of the small intestine) is recommended. Usually performed under sedation, a fiberoptic tube is passed through the mouth, through the esophagus and stomach
into the duodenum and a small bit of tissue is taken to be examined under a
It is important that the patient eats a regular diet for many weeks
before the testing procedures. If the patient has already started a gluten free
diet, it may cause the tests to be falsely negative.
Once the diagnosis is made, screening for osteoporosis may be appropriate.
Since it is often familial, once one person in the family is diagnosed with
celiac disease, it is reasonable to have other close family members screened.