If total IgA is normal and tissue transglutaminase (tTG)-IgA is negative, there is a low probability of the patient having celiac disease and a biopsy may not be necessary.

The inflammation in celiac disease occurs primarily in the mucosa of the small intestine, which leads to villous atrophy.

Common clinical manifestations related to gastrointestinal inflammation include abdominal pain, malabsorption, diarrhea, and constipation.

Clinical symptoms of celiac disease are not restricted to the gastrointestinal tract.

Other common manifestations of celiac disease include failure to grow (delayed puberty and short stature), iron deficiency, recurrent fetal loss, osteoporosis, chronic fatigue, recurrent aphthous stomatitis (canker sores), dental enamel hypoplasia, and dermatitis herpetiformis.

Patients with celiac disease may also present with neuropsychiatric manifestations including ataxia and peripheral neuropathy, and are at increased risk for development of non-Hodgkin lymphoma.

The disease is also associated with other clinical disorders including thyroiditis, type I diabetes mellitus, Down syndrome, and IgA deficiency.

Celiac disease tends to occur in families; individuals with family members who have celiac disease are at increased risk of developing the disease.

More than 97 of individuals with celiac disease in the United States have DQ2 andor DQ8 HLA markers, compared to approximately 40 of the general population.

A definitive diagnosis of celiac disease requires a jejunal biopsy demonstrating villous atrophy.

Given the invasive nature and cost of the biopsy, serologic and genetic laboratory tests may be used to identify individuals with a high probability of having celiac disease.

Subsequently, those individuals with positive laboratory results should be referred for small intestinal biopsy, thereby decreasing the number of unnecessary invasive procedures (see Celiac Disease Diagnostic Testing Algorithm in Special Instructions).

In terms of serology, celiac disease is associated with a variety of autoantibodies, including endomysial, tissue transglutaminase (tTG), and deamidated gliadin antibodies.

Although the IgA isotype of these antibodies usually predominates in celiac disease, individuals may also produce IgG isotypes, particularly if the individual is IgA deficient.

The most sensitive and specific serologic tests are tTG and deamidated gliadin antibodies.

The treatment for celiac disease is maintenance of a gluten-free diet.

In most patients who adhere to this diet, levels of associated autoantibodies decline and villous atrophy improves.

This is typically accompanied by an improvement in clinical symptoms.

See Celiac Disease Diagnostic Testing Algorithm in Special Instructions for the recommended approach to a patient suspected of celiac disease.

An algorithm is available for monitoring the patients response to treatment, see Celiac Disease Routine Treatment Monitoring Algorithm in Special Instructions.

If an interpretive report is provided, the reference value field will state this.

For individuals with moderately to strongly positive results, a diagnosis of celiac disease is likely and the patient should undergo biopsy to confirm the diagnosis.

If patients strictly adhere to a gluten-free diet, the unit value of IgA-anti-tTG should begin to decrease within 6 to 12 months of onset of dietary therapy.

It should be used to identify patients who have an increased probability of having celiac disease and in whom a small intestinal biopsy is recommended.

For individuals who test negative, IgA deficiency should be considered.

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