The ARUP Laboratories published a flow diagram to aid in the serologic diagnosis of celiac disease.
Parameters:
(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
where:
• 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.
|
Serum IgA |
TTG IgA |
TTG IgG |
Age |
Gliadin |
Celiac Diagnosis |
|
>= 7 |
positive |
NA |
NA |
NA |
positive |
|
>= 7 |
negative |
NA |
< 3 |
positive |
positive |
|
>= 7 |
negative |
NA |
< 3 |
negative |
negative |
|
>= 7 |
negative |
NA |
>= 3 |
NA |
negative |
|
< 7 |
NA |
positive |
NA |
NA |
positive |
|
< 7 |
NA |
negative |
< 3 |
positive |
positive |
|
< 7 |
NA |
negative |
< 3 |
negative |
negative |
|
< 7 |
NA |
negative |
>= 3 |
NA |
negative |
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.
Specialty: Gastroenterology, Nutrition
ICD-10: ,
