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| {{Family tree | | | | | | | | A01 | | | |A01=High probability <br> (>5%)}}
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| {{Family tree | | | | | | | | |!| | | | | }}
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| {{Family tree | | | | | | | | B01 | | | |B01= • Duodenal biopsy <br> • TTGA IgG}}
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| {{Family tree | | |,|-|-|-|-|-|+|-|-|-|-|-|.| }}
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| {{Family tree | | C01 | | | | C02 | | | | C03 |C01=Both negative|C02=Both positive|C03=Serology/biopsy disagreement}}
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| {{Family tree | | |!| | | | | |!| | | | | |!| }}
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| {{Family tree | | C01 | | | | C02 | | | | C03 |C01=Celiac disease unlikely|C02=Celiac disease|C03=Needs <br> • HLA DQ2 and DQ8 genotyping <br> •IgA level ± TTGA/DGP IgG <br> •work up for other causes of villous atrophy }}
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| {{Family tree/end}}
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| __NOTOC__
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| {{Celiac disease}}
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| {{CMG}} {{AE}}: {{IQ}}
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|
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| ==Overview==
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|
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| ==Laboratory Findings==
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| ==== Electrolyte and Biomarker Studies ====
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| * Complete blood count (CBC)
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| * Liver function tests (LFTs)
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| * B12
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| * Vitamin D
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| * Folate
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| * Ferritin (+/- Ca, alk phos) – at diagnosis and annually
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|
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| == Serologic Markers ==
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| Serologic tests may be divided into 2 groups based upon antibodies against respective antigens:
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| # anti-TTG Ab tests
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| # anti-gliadin antibody tests
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| * IgA endomysial antibody (IgA EMA)
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| * IgA tissue transglutaminase antibody (IgA tTG)
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| * IgG tissue transglutaminase antibody (IgG tTG)
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| * IgA deamidated gliadin peptide (IgA DGP)
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| * IgG deamidated gliadin peptide (IgG DGP)
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|
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| === IgA endomysial assay: ===
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| * Endomysial antibodies bind to the endomysium and can be seen via indirect immunofluorescence producing a staining pattern. The target antigen is a tissue transglutaminase
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| * IgA EMA have high specificity and even low titres indicate a positive test result
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| * It has moderate sensitivity but high specificity for untreated celiac disease and is negative in treated patients.
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|
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| === Anti-tissue transglutaminase antibodies: ===
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| *These antibodies are directed against tissue transglutaminase-2 (tTG) antigen.
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| *They can be easily detected by ELISA
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| *Anti-tTG antibodies have high diagnostic accuracy
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|
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| === Antigliadin antibody assays: ===
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|
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| === NOTE: ===
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| *Serum IgA EMA and IgA tTG have the highest diagnostic accuracy
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| *The IgA and IgG antigliadin antibody (AGA) are not recommended for estabilishing diagnosis as they have low accuracy and give more false positive results when compared with IgA tTG and IgA DGP assays
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| *The anti-deamidated gliadin peptide (DGP) assays also have high diagnostic accuracy
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| :
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| ====Sensitivity and Specificity of Antibody testing:====
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| Literature review has shown that IgA endomysial and IgA tissue transglutaminase antibodies have a sensitivity more than 95% and a specificity almost 100%. However variations in results are seen among different laboratories.
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| {| class="wikitable" align="left" style="margin-right:2em"
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| |+ Blood antibody tests for coeliac disease
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| |-
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| ! width="110px" | Test !! width="90px" | [[sensitivity (tests)|sensitivity]] || width="90px" | [[specificity (tests)|specificity]]
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| |-
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| | [[IgA]] enomysial antibody || align="Center" | 85 to 98% || align="Center" | 97 to 100%
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| |-
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| | [[IgA]] tissue transglutaminase antibody || align="Center" | 90 to 98% || align="Center" | 95 to 97%
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| |-
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| | IgA deamidated gliadin peptide || align="Center" | 94% || align="Center" | 99%
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| |-
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| | IgG deamidated gliadin peptide || align="Center" | 92% || align="Center" | 100%
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| |}
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|
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| {| class="wikitable" align="right"
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| |+ Blood HLA tests for coeliac disease
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| ! width="70px" | Test !! width="90px" | [[sensitivity (tests)|sensitivity]] || width="90px" | [[specificity (tests)|specificity]]
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| |-
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| | [[HLA-DQ2]] || align="center" | 94% || align="center" | 73%
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| |-
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| | [[HLA-DQ8]] || align="center" | 12% || align="center" | 81%
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| |}
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|
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| **
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|
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| ==References==
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| <references />
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