Could a Celiac Test Show a False Negative?

  • Medical Author:
    Dennis Lee, MD

    Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Ask the experts

Is it possible to have a false negative blood test for celiac disease?

Doctor's response

Yes, it is possible. Endomysial antibodies and anti-tissue transglutaminase antibodies (blood tests for diagnosing celiac disease) are highly reliable In diagnosing celiac disease. An individual with abnormally elevated endomysial and anti-tissue transglutaminase antibodies has a greater than 95% chance of having celiac disease. Anti-gliadin antibodies are less reliable and have a higher rate of false positive tests.

However, I personally have taken care of patients with small bowel biopsies and symptoms of celiac disease, but whose blood tests (endomysial antibodies and anti-tissue transglutaminase antibodies) were normal, and as such, represented false negative tests.

There are two recognized reasons for false negative blood tests for celiac disease:

  1. Patients with deficiency of one type of antibody, IgA (they are born that way) will have low endomysial antibodies and anti-tissue transglutaminase antibodies since they are IgA-type antibodies.
  2. Patients who have self-treated themselves with a gluten-free diet for weeks to months before having these tests done can have abnormal blood tests revert to normal.

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCE:

"Diagnosis of celiac disease in adults"
UpToDate.com

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Reviewed on 7/24/2017