Celiac disease that damages the intestine is most often associated with symptoms such as diarrhea or constipation, weight loss, bloating, abdominal pain, but also fatigue, anemia and irritability (1). This lifelong immune-mediated systemic disease caused by gluten can be investigated not only genetically (by identifying genes involved in the susceptibility to celiac disease), but primarily by analyzing blood serum (by examining antibodies against the gluten-metabolizing enzyme and the gluten protein - gliadin). The sufferer's immune system creates specific antibodies in the fight against gluten, which are examined by a test (2).
Celiac disease that damages the intestine is most often associated with symptoms such as diarrhea or constipation, weight loss, bloating, abdominal pain, but also fatigue, anemia…
Celiac disease that damages the intestine is most often associated with symptoms such as diarrhea or constipation, weight loss, bloating, abdominal pain, but also fatigue, anemia and irritability (1). This lifelong immune-mediated systemic disease caused by gluten can be investigated not only genetically (by identifying genes involved in the susceptibility to celiac disease), but primarily by analyzing blood serum (by examining antibodies against the gluten-metabolizing enzyme and the gluten protein - gliadin). The sufferer's immune system creates specific antibodies in the fight against gluten, which are examined by a test (2).
Why the test of anti-gluten antibodies from the blood serum is an appropriate diagnostic step
A blood test quickly points to possible celiac disease as the cause of digestive problems, but it can also manifest itself in anemia, weight loss, fatigue, joint pain, skin rashes or lactose intolerance (3).
The essence is the determination of specific IgA antibodies against tissue transglutaminase, which is the first step in the diagnosis of celiac disease after anamnesis and clinical examination, followed by a biopsy of the mucosa of the small intestine (4) (5).
The determination of IgA antibodies from the blood is best done without dietary restrictions, without omitting foods containing gluten, otherwise it could cause false negativity (2).
You will receive the test result within 7 working days.
Examination for celiac disease/gluten intolerance is also suitable for children and adults, regardless of age.
When is it appropriate to take a serological test for celiac disease/gluten intolerance?
In celiac disease, the immune system creates antibodies in the fight against gluten. These antibodies in the intestine "mistakenly" attack tissue transglutaminase, which is normally involved in the metabolism of gluten (the so-called deamination of gliadin) (6). This autoimmune reaction causes a number of unpleasant symptoms. It is advisable to undergo a test for celiac disease/gluten intolerance if you experience any of the following symptoms after eating foods containing gluten:
Gastrointestinal:
abdominal pain,
bloating and/or flatulence,
diarrhea and/or constipation,
nausea and/or vomiting (7).
Extraintestinal:
anemia,
fatigue and headaches,
joint pain,
concentration problems, anxiety, depression,
skin manifestations (rash) (7).
In addition to the above symptoms, we recommend that you undergo an examination, even if you have someone in your family who suffers from celiac disease, or if you have an autoimmune disease - type 1 diabetes or Hashimoto's thyroiditis (2).
Many people with gluten intolerance also have irritable bowel syndrome (IBS). Examination of antibodies against tissue transglutaminase IgA is essential to confirm/disprove whether celiac disease/gluten intolerance or another multifactorial disease is really hidden behind these symptoms (2) (8) (9).
Gluten intolerance or celiac disease
What else you should know before taking a serological test for celiac disease/gluten intolerance
There is a difference between gluten intolerance and celiac disease, although they are mistakenly confused and have similar symptoms that arise after eating grain foods. Sarmed Sami, a gastroenterologist at Mayo Clinic Healthcare in London, answered the question of what is the difference between these terms. "Consumption of gluten, a grain protein found in wheat, barley, rye and other grains, triggers a severe autoimmune reaction in celiacs that damages the cells of the small intestine. With gluten intolerance, cell damage and inflammation do not occur. It's more about hypersensitivity. If you have an immediate reaction after eating gluten (most often in the form of diarrhea), you suffer from gluten intolerance rather than celiac disease, which is characterized by a slow process, and you don't have a chance to feel it immediately." (10)
In the case of gluten intolerance, it is usually enough to limit the intake of gluten in food and the gastrointestinal symptoms will be reduced or disappear completely. "However, it depends on the degree of intolerance. For some, it is enough to cut the dose of gluten in half, for others, it is necessary to limit it more," says Sami. "This is the difference from celiac disease, where the patient must be strictly, completely and lifelong gluten-free." Diagnosing gluten intolerance and celiac disease traditionally begin with a blood test that determines whether the body considers gluten to be an intruder and creates antibodies against it. If the serological test is positive, an endoscopy and biopsy will be performed, that is, a tissue sample will be taken, from which the degree of damage to the small intestine will be determined. "Without a clear diagnosis of celiac disease, there is no reason to exclude gluten from the menu," concludes Sami (10).
Notice
The definitive diagnosis is determined by a physician, based on further tests.
If you require consultation regarding the results of the intolerance package, we recommend seeking guidance from a clinical immunologist and allergist.
What’s inside
Blood dif. test
CBC allows to detect anemia and thus impaired oxygen supply to tissues, exclude infection or malfunction of the immune system and suspect blood clotting disorders or the risk of blood clots.
Antibodies to deamidated gliadin IgG
Antibodies to deamidated gliadin IgA
Immunoglobulin A
Antibodies to tissue transglutaminase IgA
Antibodies to tissue transglutaminase IgG
What’s measured
About celiac disease and diseases associated with gluten
In connection with gluten-associated disorders, doctors recognize different medical terms that are often confused by the lay public, namely:
an autoimmune-induced disorder is celiac disease (eng. Celiac Disease) (11),
a disorder caused by an allergy is an allergy to gluten (IgE/nonIgE) (12),
a disorder that is not caused by autoimmunity or allergy is gluten sensitivity or non-celiac gluten sensitivity (NCGS) (11).
The symptoms of gluten intolerance and celiac disease are similar, but fundamentally different, as we explained above. Celiac UK comes up with an even more detailed explanation:
Celiac disease is not a food allergy or intolerance, it is an autoimmune disease.
Allergy to gluten/wheat proteins is a reaction to proteins found in wheat and other grains, mediated by the immune system and occurring within seconds or minutes after consuming gluten.
Non-celiac gluten sensitivity (intolerance) is a condition with symptoms similar to celiac disease, but with unclear involvement of the immune system because no antibodies are produced and there does not appear to be damage to the intestinal lining (13).
The question is how to determine individuals affected by celiac disease. Screening of asymptomatic individuals within the general population is not recommended (14).
TIP: Does celiac disease run in your family?
Professional publications recommend considering celiac disease screening in asymptomatic first-degree relatives of patients with a confirmed diagnosis of celiac disease (14) (15). Serological testing is recommended for people who have any of the following symptoms:
Gastrointestinal symptoms:
chronic or recurrent diarrhoea or constipation,
unexplained weight loss,
abdominal pain, bloating.
Other symptoms:
iron deficiency anemia after excluding other causes,
irritable bowel syndrome,
peripheral neuropathy, ataxia (16).
Tissue transglutaminase (tTG)-IgA antibody testing is the preferred test for detecting celiac disease in adults (17). As part of the test, the level of total IgA is also measured. In patients with IgA deficiency, an IgG test against deamidated gliadin peptides (DGP)-IgG is performed. An alternative approach is a test based on both IgA and IgG, especially tTG-IgA and DGP-IgG, in patients with a high probability of celiac disease.
The Gluten Intolerance package contains the following tests:
Blood count with differential counts
Blood count with differential counts can reveal anaemia, infection, or immune disorders.
(tTG)-IgA, (tTG)-IgG
Antibodies against tissue transglutaminase class IgA, IgG belong to the basic examinations of celiac disease.
(DGP)-IgA, (DGP)-IgG
Antibodies against deamidated gliadin class IgA, IgG represent an examination that has higher specificity and sensitivity compared to the determination of antibodies against natural gliadin, which was used in the past in the diagnosis of celiac disease. This test is used to screen for celiac disease in individuals with IgA deficiency, which affects 2 to 3% of celiac patients.
Total IgA
It is used to check for IgA deficiency, a condition that is often associated with celiac disease and can cause a false-negative tTG-IgA or EMA result. If you suffer from IgA deficiency, your doctor may order a DGP-IgG or tTG-IgG test.
Instructions before collection
We do not recommend entry of patients/clients with clinical signs of disease (temperature, cough, signs of respiratory tract infection, etc.) to undergo this test. We recommend hand disinfection prior to entry to the clinics/collection points.
It is advised to fast for a minimum of 8 hours by refraining from eating or drinking anything expect water. Faiing to fast before the test may affect result quality. If you are currently on medications, consult your healtcare provider to determine whether you should continue taking them prior to the test.
PREPARATION FOR BLOOD COLLECTION The recommended time to collect blood is between 7 a.m. and 9 a.m., to obtain comparable results from different blood draws. To assess the numerical test result, so-called reference intervals are used, which are based on morning fasting collections and are used for population comparison. This time interval is also recommended in light of the biological cycles that naturally take place in the body.
GENERAL PRE-SAMPLING INSTRUCTIONS It is necessary to come to the testing site earlier, so that you can rest in the waiting room for approximately 20 minutes to have a relatively relaxed body and mind. It is not advisable to draw blood before collection. It is necessary to arrive on an empty stomach for the collection itself, in the case of collections at a later time in the day, at least three hours on an empty stomach. At home, it is desirable to drink a sufficient amount of pure water (at least up to half a liter) - this is important for a successful blood collection. Mineral water, juice, coffee and tea are not recommended. Herbs included in tea may contain substances affecting the blood count. Coffee and black tea increase gastric acid production and release insulin from the pancreas, thereby affecting glucose metabolism. Since everything in the body is interrelated, they can impact other tests. Another extreme is when your body is running out of fluids. In this case, the number of red blood cells, the level of protein and lipids bound to the protein increase and the level of urea in the blood can also increase. It is therefore advisable to drink pure water when you wake up.
Generally, it is recommended to: • around 6 p.m. eat only light meals, do not eat fatty food (cheese, butter, cream, meat, smoked meat, bacon) and sweet meals, • fast for 10-12 hours (Attention: it is not advisable to starve for more than 16 hours!), in the case of later collection (after 9:30 a.m.), a lighter breakfast is allowed, no later than 3 hours before collection, • drink non-alcoholic beverages and drinks without sugar in the usual quantity, in the case of adult clients 24 hours before blood collection (Alcohol in the blood changes lipid levels, the level of glucose is reduced, uric acid levels increase and liver enzymes are released into the blood), • take only prescribed medicines in the evening, • avoid increased physical activity, and strength and endurance exercise the day before blood collection (Lipid, glucose, some enzyme levels in the blood and other parameters may change during physical activity. The recovery of normal values to maintain the accuracy of laboratory results may take a longer time, depending on the duration of the exercise, your physical fitness in general and other factors. We recommend maintaining normal daily physical activity such as light stretching, short cycling to work, gardening, etc.), • avoid psychological stress, which raises blood glucose levels and causes the release of stress hormones in particular, • avoid smoking for at least 6 hours prior to blood collection because it increases the level of carbonylhemoglobin produced by the reaction of the blood dye with carbon monoxide and alters the permeability and elasticity of the vessels, affecting the ratios of blood analytes, • do not chew gum for at least 6 hours before blood collection, as this may affect glucose and enzyme levels, • do not undergo stressful diagnostic or therapeutic interventions for at least 24 hours prior to blood collection. If any of the tests you have selected require special preparation, you will be informed of the fact by email with the order and blood collection instructions attached. These specific instructions have priority over the general recommendations for preparation.
MEDICINES It is recommended to have blood collected before the planned doses of medicines. If it is not possible to take the medicine later, you should inform the nurse during blood collection and specify what medication you have taken. Take the medicines prescribed by your doctor in the morning or bring them with you to take them after blood collection (thyroid medicines, antihypertensive medicines, blood thinners, contraceptives, etc.) In the case of later collection (after 9:30 a.m.), you can take the prescribed medication in the morning. Do not take iron, vitamin, nutritional supplements or other supplements, including homeopathics, for at least three (3) days prior to blood collection.
SPECIFIC SITUATIONS In order to obtain the appropriate answers to your questions with regard to the laboratory tests, it is important to accurately notify the nurse at the healthcare provider about the following facts prior to your blood test: • regularly used medicines and supplements (ideally come with a written list to the blood collection site), infectious diseases you suffer from (e.g., HIV, hepatitis, mononucleosis...), • contact with an infected person or presence in an infectious environment, • if you have received an infusion within the last 5 days, specify into which limb, • intramuscular injections within 3 days prior to the blood collection date, • long-term immobilisation, lost ability to move, • activities at higher altitudes, • allergy to common band-aids, • if you feel unwell when looking at blood or needles, please also notify our blood collection staff of the fact.
OTHER FACTORS Please note that prolonged use of medication or other important factors may affect the values measured by the tests you have selected. For more information, please see the description of the specific test. To obtain objective test results, take the time to properly prepare for your blood collection.
(4) De Leo, L., Bramuzzo, M., Ziberna, F., Villanacci, V., Martelossi, S., Di Leo, G., Zanchi, C., Giudici, F., Pandullo, M., Riznik, P., Di Mascio, A., Ventura, A., & Not, T. (2020). Diagnostic accuracy and applicability of intestinal auto-antibodies in the wide clinical spectrum of coeliac disease. EBioMedicine, 51, 102567. Dostupné online na: https://doi.org/10.1016/j.ebiom.2019.11.028. [cit. 22-10-2024].
(5) Nevoral, J., CSc. (2020). Diagnostika celiakie u dětí, kdy je a kdy není potřeba biopsie. In PEDIATRIE PRO PRAXI (Vol. 21, Issue 3, pp. 164–167). Dostupné online na: https://www.pediatriepropraxi.cz/pdfs/ped/2020/03/05.pdf. [cit. 22-10-2024].
(6) Lewis, N. R., & Scott, B. B. (2009). Meta-analysis: deamidated gliadin peptide antibody and tissue transglutaminase antibody compared as screening tests for coeliac disease. Alimentary Pharmacology & Therapeutics, 31(1), 73–81. Dostupné online na: https://doi.org/10.1111/j.1365-2036.2009.04110.x. [cit. 06-09-2024].
(7) Therrien, A., Kelly, C. P., & Silvester, J. A. (2019). Celiac Disease. Journal of Clinical Gastroenterology, 54(1), 8–21. Dostupné online na: https://doi.org/10.1097/mcg.0000000000001267. [cit. 22-10-2024].
(14) Aggarwal, S., Lebwohl, B., & Green, P. H. R. (2011). Screening for celiac disease in average-risk and high-risk populations. Therapeutic Advances in Gastroenterology, 5(1), 37–47. Dostupné online na: https://doi.org/10.1177/1756283x11417038. [cit. 06-09-2024].
Gluten intolerance (also celiac disease) is an autoimmune disease in which the body reacts to gluten, a protein found in wheat, rye and barley. Typical symptoms include diarrhea or constipation, bloating, abdominal pain, intestinal bleeding, but also fatigue, nervousness, headache or weight loss due to nutrient deficiencies.
Gluten (wheat) allergy is an excessive immune system reaction to gluten mediated by IgE or non-IgE antibodies and is associated with rapidly occurring unpleasant symptoms after consuming a specific type of food containing gluten, e.g. wheat, but not other gluten grains. Celiac disease (gluten intolerance) is an autoimmune disease, the immune system reacts abnormally to gluten and causes inflammation and damage to the small intestine.
The easiest and most effective way is to undergo a gluten intolerance test, both genetic and serological, in which we will determine both the hereditary predisposition to the development of the disease, as well as the (ab)presence of antibodies against the gluten-digesting enzyme. You will receive the test result within 15 working days.
The symptoms of celiac disease are generally variable and there is no clear definition of a typical “celiac” stool. Some patients may also have constipation, but diarrhea is more common, when the stool is watery and loose, may also be oily and bulky, is difficult to flush, and may have an unpleasant odor.
At Unilabs, we have prepared for you a genetic and a serologicaltest for gluten intolerance, which will reveal whether a hereditary predisposition or the presence of antibodies in the serum is behind long-lasting digestive problems.
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