Diagnosing Celiac

 

Celiac disease has earned itself the name "the thousand-faced phenomenon" because of the many symptoms that are associated with it.
What are the symptoms, and what tests are necessary for diagnosis?

 

Celiac disease causes many physiological and behavioral symptoms: anemia, pallor, bloating, stomach pain and other stomach problems (diarrhea or constipation), lack of appetite, vomiting, slowed growth and sexual development, fatigue and lack of concentration, irritability, liver dysfunction, thyroid problems, respiratory problems, hair loss, hormonal disorders, infertility, and muscle depletion. Not all symptoms appear together, and in some cases none appear at all, yet the diagnosed individual must refrain from consuming gluten so as not to endanger his/her health.

The multiplicity of the symptoms and the lack of consistency in their appearance once made diagnosis very difficult. However, newfound awareness over the past few years, along with developments in medical research, have made the diagnosis process a lot easier, as well as more commonly available and accurate.

Blood Tests and Biopsies for the Diagnosis of Celiac

Diagnosis is based on a combination of blood tests and a biopsy. The results are reviewed by an endocrinologist or an expert gastroenterologist. In the first stage, a serological blood test is conducted, to detect four antibodies against the gliadin component, which is present in gluten. The presence of these antibodies suggests a high probability of celiac disease.

- Testing for TTG (Tissue Transglutaminase) Antibodies (A serological test to detect TTG antibodies):

These antibodies attack the Transglutaminase enzyme, which is an enzyme present in many of the tissues in the human body.

- Testing for EMA Antibodies (A more accurate – yet more expensive - test):

The combination of both tests (to detect both EMA and TTG antibodies) increases the probability of celiac.

There are cases in which the results will be positive even in a person who is not sensitive to gluten. The opposite is true as well – a person may have celiac even if these antibodies were not detected. That is why the final diagnosis of celiac is made by taking a biopsy – a sample of the tissue within the small intestine (through an endoscopy done under full anesthesia), where the changes can be seen in the intestinal mucosa.

When would be a good time to go for diagnosis?

Contrary to past belief, celiac is not exclusively a babies' problem. The disease can appear in adults, after years of dormancy. Therefore, in any case where celiac is suspected, with the appearance of one or more symptom, the recommendation is to go to a specialist and have both tests performed.