Original criteria:
(1) characteristic morphologic abnormalities of small bowel mucosa while the patient is on a diet containing gluten
(2) improvement or normalization of small bowel biopsy findings while the patient is on a gluten free diet
(3) deterioration of small bowel morphologic features during the gluten challenge
Revised criteria (1990, Working Group of European Society of Paediatric Gastroenterology and Nutrition):
(1) characteristic morphologic abnormality of small bowel mucosa while the patient is on a diet containing gluten
(2) while on a gluten-containing diet, the presence of serum IgA antibodies to one or more of the following:
(2a) gliadin (AGA, least sensitive but cheap)
(2b) endomysium (IgA-EMA)
(2c) tissue transglutaminase (IgA—tTG)
(3) clinical remission within a few weeks of starting a gluten-free diet
(4) disappearance of antibodies within a few weeks of starting a gluten-free diet
False negatives for IgA antibodies may occur in patients who are IgA deficient. If there is a good clinical suspicion for celiac disease and the antibody tests are negative, then the patient should have quantitation of IgA serum antibodies.
Some patients may have small bowel biopsies is an unaffected or minimally affected area, resulting in a false negative histologic diagnosis.
