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.
Who should undergo antibody blood tests for celiac disease?
Some experts recommend that antibody blood tests
should be used to screen healthy
persons with no signs or symptoms for celiac disease. In Italy, where celiac disease
is common, all children are screened for celiac disease. Experts in the United
States do not recommend screening healthy persons for celiac disease. Antibody
blood tests are only recommended for individuals with a higher likelihood than
normal of having celiac disease. These individuals are:
Individuals with chronic
diarrhea (diarrhea that does not resolve in three weeks), increased amount of
fat in the stool (steatorrhea), and weight loss
Individuals with excess gas, bloating,
and abdominal distension
First and second degree relatives of individuals who
have celiac disease
Children with growth retardation
Individuals with unexplained iron deficiency anemia
Individuals with skin rashes suggestive of dermatitis
Individuals with recurrent painful mouth sores (aphthous
Individuals with unexplained elevations of liver enzymes (AST or ALT) in the
Why is it important to accurately diagnose celiac disease?
Diagnosis of celiac disease should be firmly established before commencing
treatment with a gluten free diet for several reasons.
The gluten free diet is a life-long and tedious
commitment that should not be taken lightly. It is more costly than a normal
diet and has significant social implications, especially when dining out.
Individuals with irritable bowel syndrome (IBS) may experience improvement in bloating, abdominal pain,
and diarrhea with a gluten free diet. These individuals may be misdiagnosed as
having celiac disease. Without confirmation of celiac disease by small intestinal
biopsy, they may be unnecessarily committed to life-long gluten
A gluten free diet can lower blood antibody levels and allows the
microscopic appearance of the small intestine to lose the typical appearance of
celiac disease, complicating subsequent efforts at making a firm diagnosis of