Maine Mandates Insurance Coverage for PFAS Blood Testing

Celiac disease is a chronic autoimmune condition that affects the digestive system, particularly the small intestine. When people with celiac disease consume gluten, a protein found in wheat, barley, and rye, their immune system responds by attacking the lining of the small intestine. This immune reaction damages the tiny, finger-like projections called villi that line the intestinal wall and are responsible for absorbing nutrients from food. Over time, this damage can lead to various health complications and nutritional deficiencies.

Laboratory testing plays a crucial role in diagnosing celiac disease. The most common initial tests are blood tests that look for specific antibodies. These include tissue transglutaminase antibodies (tTG-IgA), endomysial antibodies (EMA-IgA), and deamidated gliadin peptide antibodies (DGP). Additionally, a total IgA level test is often performed because some people with celiac disease have IgA deficiency, which can lead to false-negative results on IgA-based tests. For individuals with IgA deficiency, alternative tests measuring IgG antibodies are available. It is important to note that these tests are most accurate when the person is still consuming gluten in their diet, as avoiding gluten can lead to normalized antibody levels and potentially false-negative results.

If blood test results suggest celiac disease, the next step typically involves an endoscopic biopsy of the small intestine. During this procedure, a gastroenterologist takes small tissue samples from the intestinal lining to examine under a microscope. The biopsy can reveal the characteristic damage to the villi and confirm the diagnosis. In some cases, particularly in children with very high antibody levels and specific symptoms, diagnosis may be made without a biopsy, though this approach is still debated among medical professionals.

Genetic testing for celiac disease looks for specific gene variants called HLA-DQ2 and HLA-DQ8. Nearly all people with celiac disease carry one or both of these genetic markers. However, having these genes does not mean a person will definitely develop celiac disease, as they are also present in about 30 to 40 percent of the general population. Genetic testing is most useful for ruling out celiac disease or determining whether family members of diagnosed patients are at risk. A negative genetic test makes celiac disease extremely unlikely. Following diagnosis and the initiation of a strict gluten-free diet, periodic follow-up testing with antibody blood tests can help monitor how well the intestine is healing and ensure adherence to the gluten-free lifestyle.