Description: The celiac disease comprehensive panel test screens for antibodies associated with celiac disease in your blood’s serum.
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:
- Celiac Diseae
- Autoimmune Disorders
- Lactose Intolerance
- Iron Deficiency Anemia
- Inflammatory Bowel Disease
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.
We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.