Diagnostic Challenges of Celiac Disease

Limitations of Serology

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.

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Limitations of Serology

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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?