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Exam Preparation
Before undergoing these tests it is important that the patient maintains their dietary habits, unless otherwise prescribed. For example, if the subject stops taking gluten-containing foods, he could be falsely negative in the tests used for the diagnosis of celiac disease, thus appearing healthy despite the disease.
, that is the sensations reported by the patient about his own health condition, and the clinical signs (objective symptoms detected by the doctor himself) typical of celiac disease. These symptoms are essentially of gastrointestinal origin and include dyspepsia, diarrhea or constipation, malaise, flatulence and abdominal distension; in an advanced stage these symptoms, typical of malabsorption syndromes, are accompanied by those of malnutrition: short stature in children, pubertal delay, weight loss, iron and folate deficiency anemia, vitamin deficiency, osteoporosis and osteomalacia. However, it should be remembered that the clinical spectrum of this pathology is extremely varied and heterogeneous, also as regards the intensity of the symptoms, which can present themselves in a severe or extremely nuanced manner., Crohn's disease, irritable bowel syndrome and pancreatic insufficiency) requires that, in the face of clinical suspicion, further investigations are carried out.
Among the first-line tests we recall the blood dosage of particular antibodies and autoantibodies, such as the anti-tissue transglutaminase (tTGA, the most used for diagnostic purposes), the anti-endomysium antibodies (EMA, directed against the components of the intestinal cells of the "organism) and antigliadin antibodies (AGA, directed towards components of gluten and less important from the clinical point of view due to the high rate of false positives).
If the levels of these antibodies appear higher than normal, the patient is probably celiac and therefore a candidate for further tests. Patients with high anti-tissue transglutaminase antibody titers and anti-endomysial antibodies have a more than 95% chance of being celiac.
At the moment, the validation of the use of other antibodies in the diagnosis of celiac disease is underway, such as anti-reticulin R1 (R1-ARA) and anti-fasting (JAB) antibodies.
For further information: Transglutaminase and Celiac disease - Anti-transglutaminase antibodies of celiac disease; it is performed by administering sorbitol to the patient and then measuring at regular intervals the concentration of hydrogen in the exhaled air. If this increases it means that the sorbitol has escaped absorption in the small intestine and has been fermented by the bacterial flora of the colon, with the production of intestinal gas including hydrogen.A positive sorbitol breath test therefore indicates a problem of intestinal malabsorption, common among celiac subjects but also to other diseases, for example in the case of pancreatic insufficiency, bacterial contamination syndrome of the small intestine, short bowel syndrome and Crohn's disease .
it is rarely used for the diagnosis of celiac disease, although it can be useful for identifying patients to be subjected to further investigations (screening method). In the presence of malabsorption syndromes it is possible to find an "excessive amount of fat in the fecal sample (steatorrhea) and an acidic pH of the stool. Similarly to the sorbitol breath test, the positive test is recorded in the presence of any generic cause of intestinal malabsorption. ..
The examination is carried out by means of esophagogastroduodenoscopy, during which a long and thin flexible tube is inserted through the oral cavity and made to go down the esophagus to the stomach and the first part of the intestine. This instrument is equipped with a camera with a source surgical micro-instruments can be passed through the tube to remove small samples of the intestinal mucosa, subsequently observed in the laboratory.
Since celiac disease subverts the normal architecture of the intestinal mucosa, with flattening of the villi, the cytological examination allows to confirm or exclude celiac disease with almost absolute certainty. The examination loses diagnostic value in the presence of allergies to milk or proteins of soy, in any case rare and appearing diseases, mostly in childhood, which are accompanied by overlapping histological findings; analogous discourse in the presence of viral gastroenteritis which can however be recognized a priori for the sudden onset of symptoms, for their severity and for their course over time.
Other articles on "Tests for Celiac Disease"
- Celiac disease: symptoms, risk factors, diagnosis
- Celiac disease
- Anti-endomysial antibodies
- Anti-gliadin antibodies
- Transglutaminase and diagnosis of celiac disease
- Herpetiform dermatitis: Duhring's dermatitis
- Celiac and Thyroid
- Celiac Disease - Medicines to Treat Celiac Disease
- Celiac disease: nutrition, advice, therapy
- Gluten-free foods
- Celiac disease
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