What is the best test to do if I think I have celiac disease?

What is celiac disease?

Celiac disease is an autoimmune disease of the bowel. When individuals with celiac disease eat foods containing "gluten" (such as barley, rye, wheat), inflammation develops in the small bowel. This leads to damage to the small bowel which prevents it from properly absorbing food.  Celiac disease can develop at any age. It’s more common in Caucasians and those of European ancestry. Women are affected to a greater extent than men.

Patients with celiac disease may have many symptoms.  The most common symptom is diarrhea that lasts many weeks or months (termed "chronic diarrhea") as well as weight loss.   But a range of symptoms are possible, including abdominal pain, weight loss, bloating, gas, and constipation. In fact, celiac disease can sometime be challening to diagnose because it has many different ways of presenting.

Should patients with hair loss be tested for celiac disease?

Many patients with hair loss wonder if they should stop gluten or if they should be tested for celiac disease.  In most cases, the answer is "no."  However, testing for celiac disease may be recommended f the patient has abdominal symptoms or long standing weight loss. Sometimes I also check for celiac disease if a pateint has low iron levels that just don't seem to raise despite use of iron pills.  A very small percent of patients with autoimmune hair loss conditions (i.e. alopecia areata) do have celiac disease.  

The most common tests that are ordered to SCREEN if someone has celiac disease are:

1. Tissue transglutaminase Antibodies (tTG)

2. Endomysial Antibodies (EMA) 

3. Other tests "may" be ordered by the physician as well including IgA antibodies and specific genetic tests such as HLA-DQ2 and HLA-DQ8.

Overall, the tTG test is the best screening test. It's inexpensive, quantitative and a highly reproducible test.

What is done once a patient is diagnosed with celiac disease? 

Once diagnosed with celiac disease, a gluten free diet will be recommended. In some cases, a referral to a gastroenterologist may be recommended. Follow up blood tests may be ordered to assess how well an individual is doing with their gluten free diet.