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Lab testing for celiac patients inaccurate

A new study on children with celiac disease finds that using anti-gliadin antibodies (AGA) to monitor dietary compliance is inaccurate. The authors report an increase in the amount of children who have negative test results to gliadin (the gluten component of wheat).
CONCLUSION: Serum AGA seem no longer useful for monitoring compliance to gluten-free diet. In children where AGA are negative at diagnosis, when the child eats a normal amount of gluten, they are going to remain negative even after poor compliance.


Minerva Pediatr. 2010 Apr;62(2):119-123.

Gluten Free Society’s Stance:

This is another example of how relying on blood tests can be misleading. AGA is a test that measures one’s immune response to gliadin. It is important to understand that gliadin is only found in wheat. Additionally, gliadin is only one component of gluten found in wheat. There are several others that are never tested. It is possible to react to these other proteins without ever reacting to gliadin. Consider the following:
  • this study reported that almost 34% of the children diagnosed with celiac disease did not have positive anti-gliadin antibodies
  • anti tissue transglutaminase (another common lab test to help identify gluten sensitivity) may only be positive 40% of the time
  • antibody lab tests have a high rate of false negative results in the absence of villous atrophy (damage to the small intestine identified by microscope)
If blood tests and biopsy results commonly yield inaccurate results until the damage is severe, how do we take a preventative approach to gluten avoidance? The answer lies in genetic testing. In the presence of symptoms associated with gluten sensitivity, gene testing is the most clinically accurate tool to identify the presence of gluten sensitivity. Mayo clinic has already started this trend. In patients with irritable bowel syndrome, HLA-DQ genetic testing is now being recommended as a primary tool to aid in the diagnosis of gluten induced IBS. Dr. Osborne, clinical director of Town Center Wellness in Sugar Land, TX has been using this approach for several years with tremendous clinical success. Bottom line: You can wait for the gluten induced disease to become severe enough for blood tests and biopsy results to be positive, or you can be genetically tested and have and instant answer that will pre-date the onset of disease by years.

8 Responses

  1. My daughter was diagnosed by genetic testing, but 1 month later is still experiencing a lot of abdominal pain.

  2. Pingback: Anonymous
  3. My 6 year old developed diarreha for 2 weeks and then started vomitting. She became lethargic and had the “malnourished” joints. Because I was diagnosed with Celiacs, my family doctor had no problem running the blood tests. They all came back VERY positive. The Pediatric Gastroenterologist said that a scope/biopsy of the small intestine wasn’t necessary due to her high levels of antibodies. She was diagnosed in Aug 2009 and her 6 month tests were down by 3/4. still a ways to go to be “normal”.

  4. My daughter was diagnosed by genetic testing, but 1 month later is still experiencing a lot of abdominal pain.

  5. For years, my doctor diagnosed me with IBS. She said as a student, it is normal for me to have digestive problems due to stress. I had random diarrhea/constipation, constant bloating, anemia and other malabsorption symptoms. I caught a GI bug in Mexico last year, and was extremely sick. Afterwards, I could not tolerate any gluten. I kept a food diary, which clearly showed that gluten = diarrhea. I was vomiting/diarrhea up to 10 times a day, and rapidly losing what little weight I had. My doctor did a Celiac blood test, which came back “inconclusive”. She sent me to a GI specialist who told me Celiac was rare, and that I had IBS. My doctor also sent me for a barium enema, a small intestine ultrasound, and skin prick allergy testing all of which came back clear. After 6 months of fighting with my doctor and 15 lbs, I was emaciated and miserable. I gave up on my doctor, and went gluten free. Within weeks I was feeling better. Now, 8 months gluten free, my skin tone has changed (I had to buy a darker shade of makeup), my hair has never been thicker, my skin is soft and clear, my head is clear, I sleep better, and have more energy and am happier than I could ever imagine. My bad days now are still better than what I used to consider a good day. Now if I accidentally eat gluten, my stomach swells up and I look pregnant, and have diarrhea for a few days. I do not have an official Celiac diagnosis, but there is no way I would eat gluten again to get a blood test/biopsy.

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