Diagnostic Challenges of Celiac Disease

Gluten Challenge Testing

June 2010

Gluten-challenge testing requires adequate gluten intake for long enough to develop gut lesions. Four slices of whole wheat bread daily for 4 weeks usually suffices. However, it will make patients ill and they can become quite symptomatic. There are some patients who are delayed responders and if a patient has had no symptoms develop by 4 weeks, I will usually perform serology. If it becomes positive at that point, we’ll proceed to biopsy. If it’s negative we will wait longer, for both serology and histology change to occur. Typically, I will not wait longer than 6 months, however.

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Gluten Challenge Testing

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Jump to section:

• Introduction
• Case 1: Negative Serology for Celiac Disease
• Limitations of Serology
• Case 2: Symptomatic Malabsorption
• Biopsy First?
• Comparison of Serological Tests
• Comparison of Serological Tests
• Marsh Classification
• Autoimmune Enteropathy²
• Autoimmune Enteropathy²
• False-Positive Biopsies
• False-Positive Biopsies
• Minimal Disease: Uncertain Histology
• Lymphocytic Duodenosis⁴
• Patient Presenting on Gluten-free Diet
• What About Patients on Gluten-free Diet?
• Gluten Challenge Testing
• Celiac Disease and HLA Risk
• Genetic Tests-Big Limitation⁵
• References
• Questions?