The ARUP Laboratories published a flow diagram to aid in the serologic diagnosis of celiac disease.
(1) serum IgA concentration in mg/dL
(2) antibodies against tissue transglutaminase (TTG), either IgA or IgG
(3) age of the patient in years
(4) antibodies to gliadin, IgA and IgG
• TTG IgA is tested if the serum IgA is >= 7 mg/dL, else TTG IgG is measured.
• Antibodies to endomysial antigen IgA can be used in place of TTG IgA.
According to Hill (2005) serologic tests should not be the sole criteria for performing small bowel biopsy. A symptomatic patient with clinical evidence suggesting celiac disease should undergo biopsy even if the serologic testing is negative.
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Specialty: Gastroenterology, Nutrition