Celiac Disease

Order a celiac disease test to diagnose celiac disease by testing tissue transglutaminase antibody (tTG)-IgA, Endomysial antibody (EMA)-IgA, and IgA and IgG antibodies to deamidated gliadin peptide (DGP). Order from Ulta Lab Tests and learn about your health today.


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IMPORTANT - Celiac Disease Comprehensive Panel #19955 contains reflex tests - 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,

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. 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, 

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).


IMPORTANT - Celiac Disease Comprehensive Panel #19955 contains reflex tests - 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,

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. 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, 

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).


Celiac Disease - Advanced panel contained 12 tests and 70 biomarkers.

 

*Please note the Celiac Disease Comprehensive Panel #19955 contains reflex tests - 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,

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. 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, 

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).


IMPORTANT - Celiac Disease Comprehensive Panel #19955 contains reflex tests - 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,

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. 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, 

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).


IMPORTANT - Celiac Disease Comprehensive Panel #19955 contains reflex tests - 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,

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. 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, 

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).


 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).

Includes

Tissue Transglutaminase, IgA with Reflexes; Total IgA with Reflex

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,

1. Endomysial Antibody Screen (IgA) will be performed at an additional charge (CPT code(s): 86255).

If the Endomysial Antibody Screen (IgA) is positive, 

2. 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

3. Tissue Transglutaminase IgG will be performed at an additional charge (CPT code(s): 83516).

Clinical Significance

Celiac disease is caused by an immune response to gluten in genetically sensitive individuals. The diagnosis is largely based on a biopsy of the small intestine, but serologic tests also help support a diagnosis and may assist identification of patients who may require biopsy.

Tissue transglutaminase antibodies (tTG, IgA) is a marker with 95% sensitivity and specificity. Total IgA is measured because 2-3% of celiac disease patients are IgA deficient. Because tTG, IgA, and anti-Gliadin IgA tend to decrease in patients on a gluten-free diet, these markers are also used to assess dietary compliance.

The endomysial antibody (EMA, IgA) assay has high specificity for celiac disease and is used to confirm positive anti-tTG results.


Specimens from children less than 4 years of age (i.e., less than 48 months) are appropriate for this test. The test for people 4 years of age and older is the Celiac Disease Comprehensive Panel (test code 19955).

TISSUE TRANSGLUTAMINASE AB, IGA
IMMUNOGLOBULIN A
GLIADIN (DEAMIDATED) AB (IGA)

Clinical Significance

This panel assists in differentiating celiac disease from other inflammatory bowel diseases and helps avoid progression of celiac disease, particularly in children, through early identification of gluten sensitivity.

Alternative Name(s) 

Tissue Transglutaminase (tTG),Gluten Sensitivity, tTG, EMA,Gliadin Antibody


Celiac Disease Panel without Gliadin

Clinical Significance

Celiac Disease Panel without Gliadin - This panel assists in differentiating celiac disease from other inflammatory bowel diseases and helps avoid progression of celiac disease, particularly in children, through early identification of gluten sensitivity.

Includes

  • Tissue Transglutaminase (tTG) Antibody (IgA)
  • IgA (Immunoglobulin A)

Methodology

Immunoassay (IA) • Immunoturbidimetric

Reference Range(s)

Tissue Transglutaminase (tTG) Antibody (IgA)

<15.0 U/mL Antibody not detected
≥15.0 U/mL Antibody detected


IgA (Immunoglobulin A)

Cord Blood 1-3 mg/dL
1-28 days 2-40 mg/dL
1-3 months 3-40 mg/dL
4-6 months 7-47 mg/dL
7-11 months 12-53 mg/dL
1 year 20-73 mg/dL
2 years 20-99 mg/dL
3-5 years 22-140 mg/dL
6-8 years 31-180 mg/dL
9-11 years 33-200 mg/dL
12-16 years 36-220 mg/dL
17-60 years 47-310 mg/dL
≥61 years 70-320 mg/dL

 

 

Result Code Result Name LOINC Code Component Name
40000700  TISSUE TRANSGLUTAMINASE AB, IGA  31017-7  Tissue transglutaminase Ab.IgA 
45073600  IMMUNOGLOBULIN A  2458-8  IgA

GI-1. Celiac Disease

  • CBC (includes Differential and Platelets)
  • Comprehensive Metabolic Panel (CMP)
  • Gliadin (Deamidated Peptide) Antibody (IgG, IgA)
  • Immunoglobulin A
  • Tissue Transglutaminase (tTG) Antibody (IgA)

GI-2. Celiac Disease

  • C-Reactive Protein (CRP)
  • CBC (includes Differential and Platelets)
  • Comprehensive Metabolic Panel (CMP)
  • Ferritin
  • Folate, Serum
  • Gliadin (Deamidated Peptide) Antibody (IgG, IgA)
  • Immunoglobulin A
  • Iron and Total Iron Binding Capacity (TIBC)
  • Tissue Transglutaminase (tTG) Antibody (IgA)
  • Vitamin B12 (Cobalamin)

GI-3. Celiac Disease

  • C-Reactive Protein (CRP)
  • CBC (includes Differential and Platelets)
  • Comprehensive Metabolic Panel (CMP)
  • Ferritin
  • Folate, Serum
  • Gliadin (Deamidated Peptide) Antibody (IgG, IgA)
  • Immunoglobulin A
  • Iron and Total Iron Binding Capacity (TIBC)
  • Tissue Transglutaminase (tTG) Antibody (IgA)
  • Vitamin B12 (Cobalamin)
  • Vitamin D, 25-Hydroxy, Total, Immunoassay
    Fecal Globin by Immunochemistry (InSure®)

GI-4. Celiac Disease

IMPORTANT: This panel includes two Reflux tests, that if positive the lab will run additional tests at an additional charge.

  • C-Reactive Protein (CRP)
  • CBC (includes Differential and Platelets)
  • Comprehensive Metabolic Panel (CMP)
  • Endomysial Antibody Scr (Iga) W/Refl To Titer

Endomysial Antibody (IgA) Screen with Reflex to Titer.

If Endomysial Antibody (IgA) Screen is positive, Endomysial Antibody Titer will be performed at an additional charge.

IMPORTANT - AN ADDITIONAL CHARGE BE APPLIED FOR THE Endomysial Antibody Titer test if run by the lab.

  • Fecal Globin by Immunochemistry (InSure®)
  • Ferritin
  • Folate, Serum
  • Gliadin (Deamidated Peptide) Antibody (IgG, IgA)
  • Immunoglobulin A
  • Iron and Total Iron Binding Capacity (TIBC)
  • Reticulin IgG Screen with Reflex to Titer

Note: If Reticulin Antibody (IgG) Screen is Positive, Reticulin (IgG) Titer will be performed at an addtional charge.

 

  • Tissue Transglutaminase (tTG) Antibody (IgA)
  • Vitamin B12 (Cobalamin)
  • Vitamin D, 25-Hydroxy, Total, Immunoassay

Serum albumin measurements are used in the monitoring and treatment of numerous diseases involving those related to nutrition and pathology particularly in the liver and kidney. Serum albumin is valuable when following response to therapy where improvement in the serum albumin level is the best sign of successful medical treatment. There may be a loss of albumin in the gastrointestinal tract, in the urine secondary to renal damage or direct loss of albumin through the skin. More than 50% of patients with gluten enteropathy have depressed albumin. The only cause of increased albumin is dehydration; there is no naturally occurring hyperalbuminemia

Increased CRP levels are found in inflammatory conditions including: bacterial infection, rheumatic fever, active arthritis, myocardial infarction, malignancies and in the post-operative state. This test cannot detect the relatively small elevations of CRP that are associated with increased cardiovascular risk.

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Serum calcium is involved in the regulation of neuromuscular and enzyme activity, bone metabolism and blood coagulation. Calcium blood levels are controlled by a complex interaction of parathyroid hormone, vitamin D, calcitonin and adrenal cortical steroids. Calcium measurements are useful in the diagnosis of parathyroid disease, some bone disorders and chronic renal disease. A low level of calcium may result in tetany.

A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Comprehensive Metabolic Panel


Endomysial Antibody (IgA) Screen with Reflex to Titer.

If Endomysial Antibody (IgA) Screen is positive, Endomysial Antibody Titer will be performed at an additional charge.

IMPORTANT - AN ADDITIONAL CHARGE OF $48.50 WILL BE APPLIED FOR THE Endomysial Antibody Titer test if run by the lab.


The fecal occult blood test is an immunochromatographic fecal occult blood test that qualitatively detects human hemoglobin from blood in fecal samples. This is a useful screening aid for detecting primarily lower gastrointestinal (G.I.) disorders that may be related to iron deficiency anemia, diverticulitis, ulcerative colitis, polyps, adenomas, colorectal cancers or other G.I. lesions that can bleed. It is recommended for use by health professionals as part of routine physical examinations and in screening for colorectal cancer or other sources of lower G.I. bleeding.

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Useful in the diagnosis of hypochromic, microcytic anemias. Decreased in iron deficiency anemia and increased in iron overload.


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Folic acid deficiency is common in pregnant women, alcoholics, in patients whose diets do not include raw fruits and vegetables, and in people with structural damage to the small intestine. The most reliable and direct method of diagnosing folate deficiency is the determination of folate levels in both erythrocytes and serum. Low folic acid levels, however, can also be the result of a primary vitamin B12 deficiency that decreases the ability of cells to take up folic acid

Detection of antibodies to gliadin, one of the major protein components of gluten, is a sensitive assay useful in diagnosing celiac disease. However, gliadin antibodies may be found in individuals without celiac disease; thus gliadin antibody assays are less specific than assays measuring antibodies to endomysium and transglutaminase. Recent work has revealed that gliadin-reactive antibodies from celiac patients bind to a very limited number of specific epitopes on the gliadin molecule. Further, deamidation of gliadin results in enhanced binding of gliadin antibodies. Based on this information, assays using deamidated gliadin peptides bearing the celiac-specific epitopes have much higher diagnostic accuracy for celiac disease when compared to standard gliadin antibody assays.

Detection of antibodies to gliadin, one of the major protein components of gluten, is a sensitive assay useful in diagnosing celiac disease. However, gliadin antibodies may be found in individuals without celiac disease; thus gliadin antibody assays are less specific than assays measuring antibodies to endomysium and transglutaminase. Recent work has revealed that gliadin-reactive antibodies from celiac patients bind to a very limited number of specific epitopes on the gliadin molecule. Further, deamidation of gliadin results in enhanced binding of gliadin antibodies. Based on this information, assays using deamidated gliadin peptides bearing the celiac-specific epitopes have much higher diagnostic accuracy for celiac disease when compared to standard gliadin antibody assays.

Detection of antibodies to gliadin, one of the major protein components of gluten, is a sensitive assay useful in diagnosing celiac disease. However, gliadin antibodies may be found in individuals without celiac disease; thus gliadin antibody assays are less specific than assays measuring antibodies to endomysium and transglutaminase. Recent work has revealed that gliadin-reactive antibodies from celiac patients bind to a very limited number of specific epitopes on the gliadin molecule. Further, deamidation of gliadin results in enhanced binding of gliadin antibodies. Based on this information, assays using deamidated gliadin peptides bearing the celiac-specific epitopes have much higher diagnostic accuracy for celiac disease when compared to standard gliadin antibody assays.

Celiac disease is a multigenic immune-mediated enteropathy triggered by dietary proteins, commonly known as glutens, present in wheat, barley, and rye. Varied clinical manifestations begin either in childhood or adult life. Its prevalence in the united states ranges from 0.5 to 1%. Celiac disease is strongly associated with the HLA genetic region. Approximately 90% of celiac patients express the HLA-DQ2 molecule. Most of the DQ2 negative patients express the HLA-DQ8 molecule. Gluten peptides presented by these HLA molecules induce an abnormal mucosal immune response and tissue damage. The HLA-DQ molecules are heterodimers of an alpha and a beta chain. The beta chain of HLA-DQ2 is coded by HLA-DQB1*02 and of DQ8 by HLA-DQB1*0302. HLA-DQB1 genotyping allows clinicians to evaluate the genetic predisposition for celiac disease in a patient.


Celiac disease is an autoimmune disorder that disrupts the body's ability to digest gluten. Gluten is a dietary protein in wheat products; the disease also affects some related proteins found in barley and rye. Celiac causes the small intestine to become inflamed when exposed to gluten; the inflammation can damage or destroy the intestine's lining.

The intestinal wall is studded with villi, projecting folds of tissue that increase the surface area available to absorb nutrients (including vitamins, fluids, minerals, and electrolytes) from food. When a person with celiac disease eats gluten, it triggers the body's immune system. Immune cells will attack the intestinal villi. This immune response usually, but not always, involves the production of auto-antibody proteins by the immune system.

The harmful immune response and autoantibody production will continue if the individual is exposed to gluten and the other relevant proteins. Over time, the immune system can do enough damage to the intestinal villi to reduce the body's ability to absorb nutrients. This results in the affected person developing symptoms associated with malnutrition.

Celiac disease occurs all over the world, with individuals of European descent being more likely to experience it. In the United States, celiac disorder occurs at a rate of one case in 100 to 150 individuals. Women are slightly more susceptible than men. While celiac can develop at any age, it is mostly seen in infants or people between 30 and 50 years of age.

Adult celiac disease was much less common at one time, and infant celiac disease was much more serious. The disease's demographics have changed, with the frequency of adult cases growing more abundant in recent years.

The celiac disorder is an inherited condition, but it appears that some event — physical, environmental, or psychological — is required to trigger the disease. The mechanism that causes celiac to manifest is not yet fully understood by doctors.

Data from the National Digestive Diseases Information Clearinghouse points out the genetic component of celiac disease. The celiac disorder is more common among the first-degree relatives (parents, children, and siblings) of individuals who already have it. The celiac disorder occurs in approximately 4 to 12 percent of first-degree relatives of those who already have it.

Celiac Disease Symptoms

Researchers estimate that there may be as many as 20 million people with celiac worldwide, with two to three million of them in the United States. Exact figures are difficult to come by as 90 percent of people with celiac disorder in the US go undiagnosed. One fact that makes the disease hard to pin down is that individual sufferers' symptoms vary widely.

How celiac disorder manifests tends to vary based on age and physical development. Digestive symptoms are more common in infants and children. At the same time, adult sufferers tend to experience symptoms affecting other parts of the body. The symptoms of celiac disease can also be caused by many other medical conditions, such as a food allergy. This leads to many cases going undiagnosed for years.

These are all common symptoms of celiac disease:

  • Abdominal bloating and pain
  • Chronic constipation or diarrhea
  • Vomiting
  • Greasy, foul-smelling stool
  • Susceptibility to bruising and bleeding
  • Pain in bones and joints
  • Fatigue
  • Mental focus problems
  • Oral ulcers
  • Dental enamel defects
  • Osteoporosis
  • Weight Loss
  • Anemia/iron deficiency that cannot be corrected via supplements

Celiac disorder can retard growth and development, delay puberty, and cause short stature in children. Adults with celiac disease may suffer from reproductive issues, including infertility.

People living with Celiac disease also often develop dermatitis herpetiformis, a skin condition that raises itchy blisters.

Celiac disorder is associated with an increased risk of developing intestinal lymphoma (cancer).

Testing For Celiac Disease

The first step in making a celiac disease diagnosis is to test for the presence of specific autoantibodies associated with the condition. A biopsy is performed to confirm the diagnosis if auto-antibody tests suggest celiac disease's presence. Further auto-antibody testing can be used to monitor the progression of celiac disease and its treatment, which is often done for symptomatic patients. Auto-antibody testing can also be used to screen relatives after one family member has been diagnosed.

There are two classes of intestinal autoantibodies that can be detected, IgA and IgG. IgA tests are more specific, leading to them being heavily preferred in diagnosing celiac disease. IgA is the most common antibody found in gastrointestinal secretions. IgG tests are still useful because a small fraction of celiac disease patients (two to three percent) also have an IgA deficiency.

Common IgA tests for celiac disease include the following:

Testing for anti-tTG antibodies in the blood is the most sensitive and specific way to detect celiac disease, so this is usually the first test performed. There is a less-sensitive test for anti-tTG in the IgG class; this usually is only used if the individual is IgA-deficient.

This test is often included in the celiac testing process because it will detect the presence of an IgA deficiency.

People with celiac disease who test negative for anti-tTG may test positive for DGP. This test is especially effective at diagnosing celiac disease in young children.

The American College of Gastroenterology recommends performing both DGP IgGtesting and anti-tTG IgG testing for any patients with low IgA levels.

There are additional auto-antibody tests that are less commonly used to diagnose the celiac disorder. These include:

This test can provide clarification if initial test results are inconclusive. EMA tests are difficult to perform when compared with anti-tTG tests.

ARA testing is surpassed by all the above tests for specificity and sensitivity. Thus, it is rarely ordered today.

As noted above, a celiac disorder diagnosis is generally confirmed by performing a biopsy on the small intestine. This can directly detect any damage to the intestinal villi. See the article on Histopathology for more information on biopsies.

There are genetic tests that can detect markers associated with celiac disease, but these are not used routinely. The key markers for celiac disease are the Human Leukocyte Antigen (HLA) markers DQ2 and DQ8. Genetic testing may be ordered for patients whose other test results are inconclusive and for screening family members in high-risk categories.

Genetic tests cannot make a conclusive diagnosis of celiac disease. The markers mentioned above are carried by roughly 30 percent of the general population, most of whom do not have the condition. Negative genetic results are useful, though, because they can rule out celiac disorder for individuals with inconclusive results on other tests (including biopsies).

Additional tests may be used to evaluate the extent of the disease and patients' symptoms. Examples include:

Order Your Celiac Blood Test Online Today

With a selection of more than 2,000 blood tests, we can help you take a comprehensive look at your overall health. If you are seeking answers about a particular condition, such as celiac disease, these tests make it easier to discover the knowledge you need.

Our easy ordering system makes it a cinch to order a celiac blood test today. You'll order your tests, visit an approved patient service center to complete your lab test or panel, and review your results via a secure portal in a matter of days. There's no reason to hesitate, especially when your health is at stake. 

You can skip past the doctor's waiting room when you order through us. You'll also ensure your personal information remains confidential the entire time. With your results in hand, you can follow up with your healthcare provider to have a more direct, informed conversation about your next steps. 

When you're ready to get started, check out our shop at ultalabtests.com. The answers you're looking for are only one click away.