The Celiac Disease Comprehensive Panel (w/ Reflexes) test contains 1 test with 4 biomarkers.
Description: The Celiac Disease Comprehensive Panel test is a blood test designed to diagnose celiac disease, an autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. This comprehensive panel consists of multiple tests that help healthcare providers accurately diagnose or rule out celiac disease in individuals suspected of having the condition.
Specimens from children less than 4 years of age (i.e., less than 48 months) are not appropriate for this test. The test for children 4 years of age and younger is the Celiac Disease Comprehensive Panel, Infant (test code 15981).
Also Known As: Anti-Tissue Transglutaminase Antibody test, tTG Test, tTGA Test, Endomysial Antibody Test, EMA Test, DGP Test
Collection Method: Blood Draw
Specimen Type: Serum
Test Preparation: No preparation required
IMPORTANT - Note this is Reflex Test which if additional tests are run you will be charged for the specific tests that the lab peforms. Additional test will be run if the following criteria are met.
If the Tissue Transglutaminase IgA is positive,
- Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).
- If the Endomysial Antibody Screen (IgA) is positive, Endomysial Antibody Titer will be performed at an additional charge (CPT code(s): 86256).
- If the Total IgA is less than the lower limit of the reference range, based on age, Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).
When is a Comprehensive Celiac Disease Panel test ordered?
Celiac disease tests are requested when signs and symptoms of celiac disease, malnutrition, and/or malabsorption are present. The condition is difficult to diagnose because the symptoms are typically ambiguous and varied. The symptoms may be faint at first and go unrecognized, but they will gradually worsen or appear irregularly. The illness can affect several sections of the body.
When somebody with celiac disease has been on a gluten-free regimen for a while, one or more antibody tests may be required. This is done to ensure that antibody levels have dropped and that the diet has been successful in reversing the damage to the gut lining.
Asymptomatic people may be examined if they have a close family with celiac disease, such as a parent or sibling, but celiac disease testing is not suggested as a general population screening at this time.
What does a Comprehensive Celiac Disease Panel blood test check for?
Celiac disease is an autoimmune condition marked by an abnormal immune response to gluten, a protein present in wheat and related grains such as rye and barley. Antibodies to celiac disease have been created to aid in the diagnosis and monitoring of the disease as well as a few other gluten-sensitive disorders. These tests look for autoantibodies in the blood, which are produced by the body as part of the immune response.
The small intestine is inflamed, and the villi that line the intestinal wall are damaged and destroyed as a result of the immunological response. The villi are tiny tissue folds that enhance the surface area of the intestine, allowing nutrients, vitamins, minerals, fluids, and electrolytes to be absorbed. When a gluten-sensitive person is exposed to gluten, the body releases autoantibodies that attack intestinal villi constituents. When villi are damaged or eliminated, the body's ability to absorb food is greatly reduced, and signs of malnutrition and malabsorption appear.
Celiac disease was previously only diagnosed by examining a tissue biopsy of the small intestine. The emergence of less invasive blood tests to check for celiac disease has lowered the amount of biopsies required.
The level of certain autoantibodies in the blood is measured in Celiac disease blood tests. There are tests to detect the IgA and IgG classes of autoantibodies, but the ones that assess IgA are more specific and are virtually solely utilized. IgG and IgA are two of five antibody protein classes produced by the immune system in reaction to a perceived danger. In gastrointestinal secretions, IgA is the most common antibody.
If a person has an IgA deficit, autoantibody testing for IgG may be ordered. This happens roughly 3% of the time in celiac disease patients and can result in false-negative test findings.
Celiac disease tests include:
- IgA anti-tissue transglutaminase antibody detects antibodies to tissue transglutaminase, an enzyme that induces protein crosslinking. The most sensitive and specific blood test for celiac disease is anti-tTG, IgA. People with an IgA deficiency may be prescribed anti-tTG from the IgG class.
- Quantitative immunoglobulin A: determines if someone is deficient in the IgA class of antibodies by measuring the total amount of IgA in their blood.
- Anti-DGP IgA antibodies are detected by deamidated gliadin peptide antibodies, IgA; like anti-tTG, the IgG class can be used to diagnose an IgA deficit.
Lab tests often ordered with a Comprehensive Celiac Disease Panel test:
- Immunoglobulin A
- Immunoglobulin G
- Fecal globulin
- Total Protein
- Iron Total
- Iron and Total Iron Binding Capacity
- Vitamin B12
- Vitamin D
- Comprehensive Metabolic Panel (CMP)
- Complete Blood Count (CBC)
- Antibody Testing
- ANA Screen
- Sed Rate
- C-Reactive Protein
Conditions where a Comprehensive Celiac Disease Panel test is recommended:
The Celiac Disease Comprehensive Panel test is ordered when there is a suspicion of celiac disease, gluten intolerance, or gluten sensitivity. Celiac disease is an autoimmune disorder that primarily affects the small intestine, causing inflammation and damage to the intestinal lining upon gluten ingestion.
How does my health care provider use a Comprehensive Celiac Disease Panel test?
Celiac disease antibody tests are used to diagnose and monitor celiac disease, an autoimmune condition caused by an abnormal immune response to gluten, a protein found in wheat and related food proteins found in rye and barley. Celiac disease tests are typically recommended for persons who have symptoms including anemia and gastrointestinal pain.
Because about four to twelve percent of people with close relatives that have celiac disease have or will develop celiac disease themselves, celiac testing may be used to screen for asymptomatic celiac disease. Those with other autoimmune illnesses may also be subjected to testing.
The number of certain antibodies in the blood is measured in Celiac disease blood tests. The following are the most common tests:
- The primary test ordered to screen for celiac disease is tissue transglutaminase antibody, IgA class. According to the American College of Gastroenterology's 2013 guidelines, it is the single test preferred by the American Gastroenterology Association and the American Gastroenterology Association for the identification of celiac disease in persons over the age of two years. If you have an IgA deficiency, you can obtain anti-tTG from the IgG class as an alternative. If the anti-tTG, IgA, or IgG test is positive, it can be used to monitor a person with celiac disease and assess treatment success; antibody levels should reduce as gluten is removed from the diet. Although these tests are called "tissue tests," they actually measure blood.
- Immunoglobulin quantification A test that is ordered in conjunction with, prior to, or after an anti-tTG test to detect IgA deficiency, which occurs in about 2-3 percent of celiac disease patients and can result in false-negative test results. If a person has an IgA deficit, a test for autoantibodies of the IgG class may be ordered.
- Antibodies to deamidated gliadin peptides, IgA or IgG, may be positive in certain celiac disease patients who are negative for anti-tTG, particularly children under the age of two. It's sometimes ordered in conjunction with or after an anti-tTG test, especially if the latter is negative. The American College of Gastroenterology recommends DGP IgG testing in addition to anti-tTG IgG testing for persons with low IgA or IgA deficiency. If the anti-DGP test is positive, celiac disease can be monitored.
Less frequently used tests include:
- Anti-endomysial antibodies – antibodies produced in response to continuing injury to the intestinal lining; tTg was discovered to be the chemical detected in this test. Anti-EMA antibodies of the IgA class are found in nearly 100% of persons with active celiac disease and 70% of people with dermatitis herpetiformis. Because the test is more difficult to perform and interpret than anti-tTg, it is utilized less frequently.
- Anti-reticulin antibody test — not as specific or sensitive as the other autoantibodies; it's identified in roughly 60% of celiac disease patients and 25% of dermatitis herpetiformis patients; it's rarely requested.
- A biopsy of the small intestine is used to confirm a diagnosis of celiac disease by looking for damage to the intestinal villi. Due to the invasive nature and high expense of a biopsy, antibody tests are frequently used to identify persons with a high risk of celiac disease.
Other tests may be conducted to establish the severity of the disease and the extent of any consequences that may occur, such as malnutrition, malabsorption, and organ involvement. Examples of tests include:
- Anti-F-actin — A positive result may suggest greater intestine damage if a person has been diagnosed with celiac disease and a health practitioner wants to assess the severity of intestinal damage.
- CBC to rule out anemia
- ESR is used to assess inflammation.
- CRP is used to assess inflammation.
- CMP is used to check electrolyte, protein, and calcium levels, as well as the kidney and liver's health.
- Vitamin D, B12, and folate are used to assess vitamin deficiency.
- To detect iron shortage, doctors use iron, iron binding capacity, or transferrin, and ferritin.
- Stool fat is used to assess malabsorption.
Because celiac disease patients may also have lactose intolerance, celiac disease testing may be combined with other intolerance and allergy testing.
What do my Celiac Disease panel test results mean?
An intestinal biopsy is usually performed after all positive and ambiguous celiac disease testing. Celiac disease is diagnosed definitively with a biopsy.
When a person with celiac disease avoids gluten from his or her diet, autoantibody levels should decrease. If they don't go down and the symptoms don't go away, there could be hidden gluten in the diet that hasn't been eliminated, or the person could have one of the uncommon kinds of celiac disease that is resistant to dietary adjustments. Rising levels of autoantibodies suggest noncompliance with a gluten-free diet when celiac disease tests are used to track progress.
Celiac disease tests may be negative if the person being tested has not consumed gluten for several weeks to months prior to the test. If the doctor suspects celiac disease, he or she may administer a gluten challenge, which involves introducing gluten into the patient's diet for several weeks or months to see if symptoms reappear. Celiac disease tests may be redone at that time, or a biopsy may be performed to look for damage to the villi in the intestine.
Most Common Questions About the Celiac Disease Comprehensive Panel test:
Understanding the Celiac Disease Comprehensive Panel Test
What is the Celiac Disease Comprehensive Panel test?
The Celiac Disease Comprehensive Panel test is a series of blood tests used to diagnose and monitor celiac disease, an autoimmune disorder that results in damage to the small intestine when gluten is ingested.
What specific tests make up the Celiac Disease Comprehensive Panel test?
The panel typically includes tests for the presence of specific antibodies like endomysial antibodies (EMA), tissue transglutaminase antibodies (tTG), deamidated gliadin peptide (DGP) antibodies, and sometimes total serum IgA.
What is the significance of these specific antibodies in celiac disease?
These specific antibodies are typically produced by the immune system in response to gluten ingestion in individuals with celiac disease. Therefore, their presence can be indicative of the condition.
What is the normal range for the Celiac Disease Comprehensive Panel test?
Normal results may vary depending on the specific tests in the panel and the laboratory performing them. Generally, the absence or presence of these antibodies in low levels is considered normal.
Interpreting Celiac Disease Comprehensive Panel Test Results
What does a positive Celiac Disease Comprehensive Panel test result mean?
A positive result suggests the presence of celiac disease. However, further confirmation is usually needed through an intestinal biopsy, as the test can sometimes give false-positive results.
What does a negative Celiac Disease Comprehensive Panel test result mean?
A negative result makes celiac disease less likely. However, it does not entirely rule it out, especially if a person is already on a gluten-free diet, which can result in false-negative results.
What does an equivocal Celiac Disease Comprehensive Panel test result mean?
Equivocal results are inconclusive and could suggest the need for further testing or retesting after a period of time.
Celiac Disease Comprehensive Panel Test and Specific Conditions
How is the Celiac Disease Comprehensive Panel test used in diagnosing Dermatitis Herpetiformis?
Dermatitis Herpetiformis (DH) is a skin manifestation of celiac disease. The panel test can aid in its diagnosis, as people with DH often have high levels of certain celiac disease-associated antibodies.
Can the Celiac Disease Comprehensive Panel test be used to monitor adherence to a gluten-free diet?
Yes, the levels of specific antibodies usually decrease when a person with celiac disease adheres to a strict gluten-free diet. Therefore, the test can help monitor dietary compliance.
Can the Celiac Disease Comprehensive Panel test diagnose non-celiac gluten sensitivity?
No, non-celiac gluten sensitivity does not trigger the same autoimmune response as celiac disease, and it doesn't result in the production of the same antibodies tested in the panel.
Can the Celiac Disease Comprehensive Panel test diagnose other autoimmune disorders?
The panel is not specifically designed to diagnose other autoimmune disorders, but because autoimmune diseases often occur together, it might indicate the possibility of other conditions.
General Questions about the Celiac Disease Comprehensive Panel Test
How do recent gluten consumption affect the Celiac Disease Comprehensive Panel test results?
Recent gluten consumption can trigger the production of the specific antibodies tested in the panel. Therefore, it is usually recommended to include gluten in the diet before the test for accurate results.
Can other conditions cause positive results in the Celiac Disease Comprehensive Panel test?
Yes, other conditions like Type 1 diabetes, autoimmune liver disease, or inflammatory bowel disease can occasionally cause positive results in the test.
Can the Celiac Disease Comprehensive Panel test differentiate between celiac disease and wheat allergy?
No, the test is not designed to differentiate between these two conditions. A wheat allergy triggers a different immune response that isn't detected by this panel.
Why is total serum IgA included in the Celiac Disease Comprehensive Panel test?
Total serum IgA is tested because some people have a deficiency in IgA, which can lead to false-negative results for the IgA-based celiac disease tests.
How can the Celiac Disease Comprehensive Panel test be useful for family members of individuals diagnosed with celiac disease?
Celiac disease has a genetic component, so family members of individuals with the disease are at a higher risk. The panel can help identify if they have the condition.
What role does the Celiac Disease Comprehensive Panel test play in diagnosing refractory celiac disease?
The test can help diagnose refractory celiac disease - a rare form of the disease that doesn't respond to a gluten-free diet - by identifying persistently high antibody levels despite dietary changes.
Can the Celiac Disease Comprehensive Panel test be used in population screening for celiac disease?
While the idea has been proposed, routine population screening with this panel is not currently recommended due to cost considerations and the possibility of false-positive results.
How can the Celiac Disease Comprehensive Panel test contribute to a diagnosis of silent or asymptomatic celiac disease?
In cases of silent or asymptomatic celiac disease, the panel can detect the specific antibodies indicative of the disease, even when typical symptoms are not present.
Can the Celiac Disease Comprehensive Panel test predict the development of celiac disease?
The presence of certain antibodies could suggest a higher risk of developing celiac disease in the future, especially in genetically predisposed individuals.
How does the Celiac Disease Comprehensive Panel test aid in diagnosing celiac disease in patients with Down syndrome?
People with Down syndrome have an increased risk of celiac disease. The panel helps to screen for and diagnose celiac disease in these individuals.
What can cause a false positive result in the Celiac Disease Comprehensive Panel test?
Certain conditions like Type 1 diabetes, autoimmune liver disease, or inflammatory bowel disease can occasionally cause false-positive results in the test.
What can cause a false negative result in the Celiac Disease Comprehensive Panel test?
Being on a gluten-free diet before the test can lead to false-negative results. Additionally, individuals with IgA deficiency may have false-negative results on the IgA-based tests in the panel.
How are results of the Celiac Disease Comprehensive Panel test confirmed?
Typically, positive results are confirmed through an intestinal biopsy, which can show the typical intestinal damage of celiac disease.
Can the Celiac Disease Comprehensive Panel test be used to reassess the diagnosis of celiac disease?
Yes, if a person was diagnosed with celiac disease but their symptoms do not improve on a gluten-free diet, the test might be repeated to reassess the diagnosis.
We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.