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what are the recommended serological tests for diagnosing celiac disease?

Answer

The serological tests recommended for diagnosing celiac disease are primarily based on the detection of specific antibodies. These include:

Anti-tissue transglutaminase IgA (tTG-IgA)

Total serum IgA

  • Total serum IgA is measured to rule out IgA deficiency, which can lead to false-negative results in tTG-IgA testing.
  • It is recommended to measure the total IgA level concurrently with serologic testing to determine whether IgA levels are sufficient

IgG-based testing

  • In patients with selective total IgA deficiency, it is recommended to obtain IgG-based testing, such as IgG-deamidated gliadin peptides or anti-tissue transglutaminase IgG, at diagnosis and follow-up
  • In patients with total IgA levels below the lower limit of detection and IgG against tissue transglutaminase or deamidated gliadin peptide, or endomysial antibody, consider these patients as having celiac disease with selective IgA deficiency rather than seronegative celiac disease

Anti-endomysial IgA (EMA-IgA)

  • Although less frequently used due to the labor-intensive nature of the test, EMA-IgA is highly specific and can be used if further confirmation is needed.

HLA determination

Ensuring correct diagnosis

In conclusion, the recommended serological tests for diagnosing celiac disease include anti-tissue transglutaminase IgA, total serum IgA, IgG-based testing in cases of IgA deficiency, and anti-endomysial IgA. HLA determination is also a useful tool in certain clinical situations. These tests should be performed while the patient is on a gluten-containing diet to ensure accurate results

References

1

Celiac disease

Diagnostic investigations

Guidelines

Serologic testing

Pathway
ESPGHAN/.../ESPGHAN 2020