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How Do You Test for Celiac Disease?
by Patricia L. Raymond, M.D., F.A.C.P., F.A.C.G.


"I just got back from Japan, and living with my parents again is driving my irritable bowel syndrome nuts!"

Tall and willowy, the young woman said words to that effect in my office. And with that, we diagnosed her promptly with celiac (pronounced SEE-lee-ak) disease. ... Promptly, my Aunt Fannie. More on that later.

First, you need to know that my classic American-beauty patient, who had recently completed high school and then was privileged to model for two years in the Orient, had suffered diarrhea and gas much of her life—and had been diagnosed with irritable bowel syndrome. But the smoking gun of recurrent symptoms on return from a rice-based diet to wheat-based America led to evaluation for celiac disease.

Why Is Celiac Disease So Underdiagnosed?

Although an estimated one in 133 Americans has celiac disease, an autoimmune disorder involving a reaction to the protein gluten in wheat, rye, and barley grains, it is woefully under-recognized here.newsletter-graphic

We, your doctors, hear little of celiac disease in medical school; I call it a one-paragraph disease. The paragraph says something like:

Some Americans have an autoimmune reaction to wheat, rye and barley. They get gas and diarrhea; the villi lining the small intestine flattens, and thus they malabsorb nutrients and sometimes have a low-iron anemia. If you just tell them to stop eating gluten they’ll be fine.

The first step to celiac diagnosis is awareness, either from you or your doctor. When we fail to think of our one-paragraph disease, we don't test for it. I test for celiac whenever it crosses my mind, most specifically for my patients with IBS-like bowel symptoms, any of the collateral diseases in the box to the right, or a family member with celiac disease.

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How Do You Test for Celiac Disease?
Testing is simple: a blood test.
After a positive finding, you get a confirmatory upper endoscopy (small tube with a camera fed down your throat, all the way to the top part of the intestines) with a small-intestine biopsy to look for flattening or inflammation of the villi.

What are villi? Think of your small intestine as looking like a shag rug. The strands of the rug are your villi, the absorptive surface of the intestine. They allow you to take in certain nutrients. Having celiac disease makes your intestinal lining transform from shag to berber.

The biopsy is the gold standard still, despite our excellent blood test. I choose to formalize the diagnosis with biopsy, as "just being off gluten" in our wheat-based world is a major hassle (and a half).

is a board-certified gastroenterologist with Simply Screening in Chesapeake, Va., and author of Colonoscopy: It'll Crack U Up.

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Last updated and/or approved: March 2011.
Original article appeared in September/October 2008 former print magazine. Bio current as of that issue. This general health-care information is not meant as individual advice. Please see our disclaimer.


Comments (3)add comment
Re: celiac isn't an allergy
written by Leigh Ann , March 28, 2011

Thank you, Jewels. This article was due for an update and has been edited.

Leigh Ann Otte
Managing Editor

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celiac isn't an allergy
written by Jewels doskicz , February 28, 2011

Great article but wrong information! As a nurse and a mother of a child with type 1 diabetes and Celiac let me tell you what it is. It is an autoimmune reaction to gluten, not an allergy. This published Gastroenterologist's information is incorrect.
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Crohn's Disease
written by Melissa , June 21, 2010

Is it easy to get Crohn's Disease and Celiac Disease confused? I have anxiety and also ADHD and recently I was in the hospital and they said "Well, we can't find anything that would support your diagnosis of Crohn's Disease" So the doctor diagnosed me with Dumping Syndrome, looking into hypothalamus dysfunction (due to not reaching puterty until 15 1/2) all these diagnosis's haven't set just right with me. I have had multiple sugeries, endoscopy's (never revealing flattened intestine but inflammation instead) and colonoscopies, laporoscopies (please excuse the spelling mistakes, I am in my college accounting class woohoo! =) But another opinion on this would be helpful. Thank you for you time.
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