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Diagnostic Challenges of Celiac Disease



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Limitations of Serology

Slide 3

June 2010

There are limitations of serology for celiac disease. A significant limitation is that of IgA deficiency. Three to 5% of patients with celiac disease are IgA deficient, and up to 10% of patients with IgA deficiency have celiac disease. Another limitation of serology is that it is less sensitive for partial villous atrophy. And, very important, is the effect of a prior gluten-free diet. Patients who have reduced or eliminated gluten from their diet may cause their serologic test to become negative, and this may occur very quickly. So it is very important when considering testing for celiac disease to ensure that the patient has been on a normal, gluten-containing diet before testing.

A solution in this regard would be to start the serologic strategy for the detection of celiac disease with a measurement of total IgA. This strategy is incorporated into both the Celiac Disease Comprehensive Cascade, as well as the Celiac Disease Serology Cascade, that use a total IgA level to drive the most logical subsequent testing to maximize the accuracy of the serologic approach to the detection of celiac disease.

Limitations of Serology

 


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