The diagnosis of celiac disease may be missed if certain conditions while evaluating the patient.


False negative serologic tests:

(1) IgA deficiency

(2) severe immunodeficiency

(3) marked immunosuppression

(4) low exposure to gluten prior to testing

(5) poor test performance by the laboratory


False negative small bowel biopsy:

(1) patchy involvement missed on random biopsies

(2) inadequate sampling

(3) low exposure to gluten prior to testing

(4) poor orientation of the villi in the biopsy specimen

(5) inexperienced endoscopist


Diagnostic errors:

(1) failure to order appropriate tests

(2) ascribing findings to another diagnosis



(1) Take multiple biopsies from multiple sites.

(2) Consider gluten challenge prior to testing.

(3) Testing should be done at a reliable laboratory.

(4) Screen the patient for depressed immunoglobulin levels.


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