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| Alan Leichtner, M.D., Associate Chief, Division of Gastroenterology and Nutrition, Children's Hospital Boston |
A:I usually recommend starting with an anti-endomysial antibody, an anti-tissue transglutaminase antibody, and a total IgA level to look for active celiac disease. If the antibody levels are elevated, he probably has active celiac disease and the next step is an endoscopy to obtain a small bowel biopsy.
If the antibody tests are negative and the IgA level is normal, one alternative is to re-screen him at intervals, perhaps every three to five years, and certainly if he develops symptoms. The other alternative is to recommend celiac genetic testing (to look for HLA DQ2 or DQ8). Negative genetic testing makes it extremely unlikely that he will ever develop celiac disease and future antibody testing would be unnecessary.
If the antibody tests are negative and the IgA is low, the antibody tests are unreliable. Special antibody tests can be performed that measure IgG antibodies rather than IgA antibodies, but the accuracy of these tests has not been well established. In this case, the genetic testing would also make sense. Because the genetic testing is expensive, it is important to make sure that your insurance company will pay for the test before it is done.
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