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Diagnostic Testing Algorithms for Celiac Disease



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Algorithm Breakdown

Slide 15

updated June 2011

For a patient who has instituted a gluten-free diet in whom the diagnosis of celiac disease has not been confirmed the Comprehensive Cascade for Patients on a Gluten-Free Diet may be appropriate.  In this algorithm, only the HLA-DQ typing is performed initially.  For those individuals who have neither the DQ2 nor DQ8 alleles, celiac disease is virtually excluded as a diagnosis.

At this point, testing for celiac disease should stop and other potential diagnoses related to the patient’s clinical presentation should be evaluated.

On the other hand, a positive result for DQ2 or DQ8 does not establish a diagnosis of celiac disease – it means only that celiac disease is a possible diagnosis. At this point, further testing should be performed, specifically all of the serologic tests.

Depending upon how long the patient has been following the gluten-free diet, and how strict the diet is, some of these serologic tests may provide a positive result.  In that case, the interpretation would be that the results of all laboratory testing are consistent with celiac disease and that a biopsy should be performed.

If all results are negative, celiac disease has not been completely ruled out, since this could simply be a reflection of a successful gluten-free diet. At this point, the clinician must determine how likely the diagnosis of celiac disease is and if further evaluation, such as a gluten challenge, should be considered.

Algorithm Breakdown

 


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