What to do when one suspects coeliac disease?

What to do when one suspects coeliac disease?

With symptoms that point to coeliac disease it is generally sufficient to do a serological examination in order to get a first diagnosis.  

A definitive diagnosis can only be given through a biopsy of the small intestine. During the biopsy tissue fragments are taken and examined histologically, in order to determine a potential villous atrophy.

Serological examinations

Serological examinations can confirm the suspicion of coeliac disease. Here, first and foremost, the anti-transglutaminase-antibodies (ATA) of the category lgA are examined. This is an extremely reliable and routine blood test. Just as significant but less common is the determination of the anti-endomysium-antibodies (EMA). The anti-gliadine-antibodies (AGA) of the category lgA and lgG are especially significant with children under the age of 3, as they give a clearer result than the other antibodies. The isolated change of AGA-lgG alone is not decisive enough for a diagnosis, except for children with an lgA deficiency.

Biopsy of the small intestine

With positive serological results a biopsy of the small intestine is recommended, which is done through a gastroscopy. If there are positive serological results, as well as typical changes in the area of the small intestine (villous atrophy, increase of the antibodies in the mucous membrane of the small intestine), then the diagnosis of coeliac disease can be definitely confirmed.

Endurance test

In case of doubt (when coeliac disease can not be clearly diagnosed) some gastroenterologists recommend reintroducing gluten into the diet, after 2 years of sticking to a gluten-free diet, for a short period of time. The diagnosis can be confirmed if after a fresh intake of gluten a clinical and bioptic relapse is caused within a few months (in seldom cases after years). The gluten exposure must occur under strict medical supervision.