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How is Celiac Disease Diagnosed?

By Alexandra Anca, MHSc, RD

How is Celiac Disease Diagnosed?

There are several ways to test for celiac disease including:



To take a biopsy of the small intestine, a gastroenterologist will perform an endoscopy, using intravenous sedation. These biopsies are then sent to a pathologist, who will be looking for variable degrees of damage compatible with celiac disease.


Blood Tests

Currently there are two serological (blood) tests commonly used in clinical practice to screen for celiac disease: IgA endomysial antibody (EMA) and IgA tissue transglutaminase antibody (tTG).


EMA Test

The IgA endomysial antibody (EMA) is highly specific for celiac disease and has a high correlation to the degree of villous atrophy.



IgA tissue transglutaminase (tTG) is an enzyme that binds to gluten and turns it into a toxic molecule. This coupling triggers the autoimmune response characteristic of celiac disease.


Gluten Challenge

If individuals have started a gluten-free diet prior to diagnosis, all screening blood tests may show normal results and a proper diagnosis could easily be missed. If the gastroenterologist suspects celiac disease, a gluten challenge may be recommended. This involves consuming gluten-containing foods daily for 3 months or more, depending on your symptoms.


Genetic Testing

Genetic testing involves detection of the DQ2 or DQ8 alleles that are closely associated with celiac disease. The tests use a blood sample, saliva, or cells obtained by swabbing the inside of the cheek.





Be sure to talk to your doctor to find out what tests are best for you.