Serology is a screening tool. A combination of Total serum IgA level and tissue Transglutaminase antibody level (tTG-IgA) is the standard screening test used. Please don’t accept a negative tTG report in the absence of the total serum IgA level. Serum IgA immunoglobulin deficiency is the most common genetic immune disorder and these patients also tend to have a higher incidence of Celiac Disease. On the other hand false positive tTG antibody is common and should not be considered diagnostic of celiac disease. The diagnosis of Celiac Disease comes from duodenal biopsy while the patient is consuming gluten.Further confirmation of the disease comes when a patient diagnosed with Celiac Disease responds to a gluten free diet.
Almost all patient with Celiac Disease have either HLA DQ2 and DQ8. Any individual who is negative for the HLA DQ2 or DQ8 gene is very unlikely to develop Celiac Disease. However genetic testing is expensive and no substitute for duodenal biopsy.
Dr Pankaj Vohra - Author – “Celiac Disease - A Comprehensive Guide (NBT Publication)”
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