Celiac and Gluten Sensitivity Test indicates the reaction of gluten with digestive system. The tTG-IgA, tTG-Igg, DGP-IgA tests help in finding causes of celiac diseases. Nowadays, home celiac, and gluten blood test kits are also available. Doctors suggest to include as gluten-free diet daily to avoid celiac disease.

Celiac disease is related to an inappropriate immune response to a segment or certain compounds of gluten protein known as Gliadin. During digestion, the presence of gluten inappropriately activates the immune system to behave adversely and cause inflammation. These adverse effects damage the organs of the body and its tissues. These are some of the fundamental and universal symptoms of celiac disease also like nausea, bloating, and abdominal pain. People typically ignore these symptoms of celiac disease, and it takes a time period of almost six to ten years to diagnose celiac disease due to unawareness. People often feel ill and use several drugs mistaking these symptoms with regular digestive problems. They might also undergo depression, and stress due to constant uneasiness until they are diagnosed within three years of celiac disease occurrence. Individuals suffering from celiac disease, commonly suffer constipation and diarrhea due to poor absorption of nutrients in the small intestine. The fundamental reason for these frequent stomach problems is also caused due to gluten intolerance. In gluten intolerance, our body's immune system starts fighting against gluten consumption. One has to adopt a lifestyle with a gluten-free diet to reduce such complications in the long run. One may undergo a gluten sensitivity test, or buy a home gluten test kit to detect gluten protein in their daily diet. Preventing gluten in the regular diet will relieve the patient in avoiding bloating, abdominal pain, and nausea. In fact, the celiac panel test is equally helpful in recognizing the substantial cause of these body problems. Celiac disease blood tests will assist the patient and a doctor in recognizing causes of celiac disease, gluten intolerance, and wheat allergy. All three conditions approximately carry similar symptoms, and through the celiac and gluten sensitivity test, celiac genetic test and gluten intolerance test, one may differentiate between them.

In this article we look at the following questions to be answered:

1. Celiac Disease Diagnosis or Test:

A maximum number of people with celiac disease are unaware of the same. Therefore, below we have mentioned two blood tests that can help in diagnosing celiac disease. It also becomes essential to get an analysis of the presence of any of the factors causing celiac disease before attempting a gluten-free diet. Eliminating gluten from one's diet, produce the outcomes of blood tests to appear normal than expected. Performing serologic tests and genetic tests is effective for identifying the necessity of an intestinal biopsy in the concerned patient. In case it is found that a patient is having genetic celiac disease, and there is a specific gene related to it, then a biopsy should be performed prior to making any changes in the diet of the patient. (1) (2)





IgA Endomysial antibody (EMA)

Total serum IgA

Deaminated gliadin peptide (DGP IgA and IgG)

Serology testing: This test examines for the presence of three antibodies in human blood. Raised levels of certain antibody proteins indicate an immune reaction to gluten. While performing a serologic test, three common antibodies are recognized as follows:

Anti-tissue transglutaminase (tTG) antibodies

Endomysial antibodies (EMA)

Deamidated Gliadin Peptide (DGP) antibodies

One out of these three tests alone cannot confirm for the presence of celiac disease in the patient. Hence, a celiac panel test or simultaneous series of these tests are performed at the time of the process of diagnosis of the condition in a patient.

Genetic testing:This test checks for the presence of human leukocyte antigens (HLA-DQ2 and HLA-DQ8), which is present genetically in patients with celiac disease. These patients usually comprise one or both the HLA components in them.

Accuracy of the test: Sensitivity and specificity are the two standard parameters with the help of which the precision of testing results is measured. Overall, all blood test reports identifying celiac diseases provide a sensitivity of 95 percent and specificity of 99 percent.



Sensitivity: It represents the ability of a test to correctly categorize a person possessing the characteristics of having celiac disease.



Specificity:It represents the ability of a test to correctly distinguish a person who is not possessing a celiac disease.

2. Different types of celiac and gluten sensitivity test:

Below is the complete explanation of tests to recognize the presence of celiac disease in the concerned patient:



Tissue Transglutaminase IgA antibody (tTG-IgA Test):The best way to identify the celiac disease is by performing a test called tTG-IgA Test along with IgA antibody. Both the tests ensure that a patient is generating enough of these antibodies to perform the celiac blood test accurately. Our immune system makes tissue transglutaminase (tTG) antibodies, which attack the enzymes in intestines to protect them. Whereas, Immunoglobulin A (IgA) is present in high concentrations in our mucous membrane. This important immunoglobulin is specifically available in our saliva and tears. Its key function is to hinder the passage for a foreign substance to enter our body's circulatory system.

Patients with celiac disease found to be positive in Tissue Transglutaminase Antibodies (tTG-IgA) are then called for another test to identify the problem. The tTG-IgA test will show positive results in 98% of cases, who are on a gluten diet and have celiac disease. This is known as "test sensitivity". The same test will perform to be negative in 95% of people in healthy people without celiac diseases, which is known as ''test specificity''.



The intensity of damaged small intestine ensures the performance of the tTG-IgA test. The test will become less sensitive within patients with milder celiac disease. The tTG-IgA test also helps in identifying the need for a gluten-free diet. The tTG-IgG test proves to be only useful for the people having a deficiency of IgA, which supposes to be 1/400 of the normal population or 2 to 3 percent of people with celiac disease.

One must follow the following instructions before going for the test:

It is necessary for a patient to be on a gluten-containing diet to ensure accurate results of the series of celiac disease blood test performed in the medical centre.

One must also inform the doctor about current drugs and medicine consumption, because certain medicines may affect the results of the tTG test.

There may be certain incorrect results of these tests in people with the following diseases who do not have celiac disease:

Autoimmune liver disease

Hashimoto’s thyroiditis

Psoriatic or rheumatoid arthritis

Heart failure, who do not have celiac disease

Type 1 Diabetes

To double-check with the results of the tTg test, one may also select other antibody blood tests specifying the availability of celiac disease. However, the ultimate way to confirm the celiac disease is a small intestine biopsy. One may go for other tests as follows:



IgA Endomysial antibody (EMA):The EMA test is highly specific and has 100% specificity for celiac disease. Due to a high technical difficulty in performing the test, the results have variable sensitivity of 70 to 100 percent which is verified under the expertise of a medical specialist. EMA test is an expensive and complicated test, which requires the use of primate esophagus or human umbilical cord. EMA test is a qualitative test, making the results more subjective than those for tTG results. Usually, EMA is used along with or as a supplement to the routine tTG-IgA test in a celiac panel test. Together tTG-IgA test and EMA provide more accurate results for the respective patient's case.

Total serum IgA: A test is utilized to examine for IgA deficiency. This deficiency of lgA can cause a false negative tTG-IgA or EMA result and the total serum IgA test helps in identifying the reason for failing the test. Basically, negative results of tTG-IgA or EMA-IgA suspecting the presence of celiac disease requires a test of selective IgA deficiency. A doctor may ask to order a DGP or tTG-IgG test in case lgA is found to be insufficient in one's body. DGP-IgG usually shows sensitive results for people with celiac disease, and it is preferable to use tTG-IgG in series of related medical tests. DGP-IgG has reasonable sensitivity for celiac disease in IgA-sufficient as well as IgA-deficient patients.

Deamidated gliadin peptide (DGP IgA and IgG): A DGP test is a new generation test better than old gliadin tests. The tests use DGP antibodies to identify sensitivity and specificity towards celiac diseases. It further examines for celiac disease in individuals with IgA deficiency or people whose tests are negative for tTg or EMA antibodies. However, it is found that the tTG test is a better and less expensive test than the DGP test offering better diagnostic performance. There is no prominent source specifying the significance use of DGP over tTG or EMA tests. It is very rare, but people with celiac disease have a possibility to have negative antibody test results.

3. Importance of Genetic testing in a celiac panel test:

Genetic testing or Human Leukocyte Antigen (HLA) testing: It is recommended to perform a genetic test in children of 3-5 years, whose first family members possess to have celiac disease. This test will help in avoiding a further series of tests later in their lives. However, if they are negatively diagnosed then, their chances to develop celiac disease reduces. Human leukocyte antigen (HLA) is the main compound in a blood test, which identifies antigens on the surface of cells and tissues. The test is also used in matching the organ transplant recipient for a compatible donor. It is observed that about 25-30% of the general population have celiac disease, and people with celiac disease carry one or both of the HLA DQ2 and DQ8 genes. The presence of HLA DQ2 and DQ8 does not confirm that one has celiac disease. In fact, it only increases the risk of having celiac diseases up to 3% than the other 1% general population. Family members having the same type of genotype develops 40% more chance associated with the risk of having celiac disease. Whereas, in general people with unknown genotype elevates the risk from 7% to 20% of having celiac disease.

One should only go for Human Leukocyte Antigen (HLA) testing in the following cases:

When one is on a gluten-free diet and celiac antibody blood testing is not accurate.

When an examination of celiac disease is not clear.

Vague antibody testing results (particularly in children under the age of 3)

Ambiguous intestinal biopsy results

The contrariety between antibody and biopsy conclusions.

A negative result confirms a 99% likelihood that the family member will NOT develop celiac disease.

A positive result indicates the family member should follow up with celiac antibody testing after every 2-3 years or promptly if symptoms develop.

If the results of these tests show indication of celiac disease, the doctor will possibly ask one of the following tests (3):

Endoscopy: This test utilizes a long tube with a tiny camera, which will go orally and passed down to the throat (upper endoscopy). The camera allows the doctor to inspect the small intestine and take a tiny tissue sample (biopsy) to examine for damage to the villi.

This test utilizes a long tube with a tiny camera, which will go orally and passed down to the throat (upper endoscopy). The camera allows the doctor to inspect the small intestine and take a tiny tissue sample (biopsy) to examine for damage to the villi. Capsule Endoscopy:This test uses a small wireless camera to get detailed internal images of the entire small intestine. The small camera remains inside a vitamin-sized capsule, which one swallows before the surgeon performs the procedure. As the capsule moves through the digestive tract, the camera captures thousands of images, which are transmitted to a recorder. This helps the doctor to find out the present condition in the patient.

4. Celiac and Gluten Sensitivity Test at Home:

A few of the medical tests have been developed, which may help in identifying celiac disease at home. Home celiac test or celiac test kit for celiac disease are now available at drug stores and on online portals. If one uses a home celiac disease test kit, it becomes important that the outcome should be discussed along with symptoms with the doctor. One may only get the end result of celiac diseases to check through a medical diagnosis with a blood test and a gut biopsy (4).



Below are a few celiac and gluten sensitivity test home tools to test for the celiac disease in cases of doubt. There are some gluten test kits, which also identify the availability of gluten and other compounds in food that make them sensitive towards celiac diseases:

Imaware: A kit contains with lancets to pierce the skin and a microcontainer to accumulate a blood sample in it. One should draw three to four drops of blood from the finger and put them in the micro-container present in the kit. Once the collection of blood is done, it has to be sent in a pre-paid bag to Micro drops CLIA-certified lab. Subsequently, the sample reaches the lab, it is processed in 48 hours. This is performed effectively with four celiac disease biomarkers testing tools, tTG-IgA, tTG-Igg, and DGP-IgA.

A kit contains with lancets to pierce the skin and a microcontainer to accumulate a blood sample in it. One should draw three to four drops of blood from the finger and put them in the micro-container present in the kit. Once the collection of blood is done, it has to be sent in a pre-paid bag to Micro drops CLIA-certified lab. Subsequently, the sample reaches the lab, it is processed in 48 hours. This is performed effectively with four celiac disease biomarkers testing tools, tTG-IgA, tTG-Igg, and DGP-IgA. Nima Gluten Tester: To use Nima Gluten Tester, one has to load it with a one-time-use type of disposable testing capsule and then insert a large sample of the food one wants to test in the tester. Wait for about three minutes until the testing of food is completed. The result will show up with the amount of gluten availability in the food (5).

To use Nima Gluten Tester, one has to load it with a one-time-use type of disposable testing capsule and then insert a large sample of the food one wants to test in the tester. Wait for about three minutes until the testing of food is completed. The result will show up with the amount of gluten availability in the food (5). GlutenTox Home: Specially made or celiac patients for gluten detection in special food for people facing celiac disease (6).

Specially made or celiac patients for gluten detection in special food for people facing celiac disease (6). Glutentox Pro: Speedy and quick gluten detection kit for foodstuff & surfaces.

Speedy and quick gluten detection kit for foodstuff & surfaces. Glutentox Sticks Plus: This comprises of semi-quantitative fast gluten detection kit.

This comprises of semi-quantitative fast gluten detection kit. Glutentox Reader: These types of sticks that read and allows automated results.

Various analytical celiac and gluten sensitivity test home tools, which detects harmful agents in food show the results on the following factors:

Gluten

Celiac Disease

G12 Antibody

Gluten Free Food

Below we have mentioned 7 symptoms of gluten intolerance:

Diarrhea and constipation

Bloating

Abdominal pain

Fatigue

Nausea

Headaches

Other general symptoms like Joint and muscle pain, depression or anxiety, confusion, severe abdominal pain, and anemia.

5. How can one get diagnosed with celiac disease test?

Non-celiac gluten sensitivity is diagnosed by a process of elimination. Specialists will first recommend for testing wheat allergy and celiac disease. If both are found to be negative, then a physician may suggest a gluten exclusion diet. If symptoms change and improve on a gluten-free diet, then one might have non-celiac gluten sensitivity (7).

It is very important that a trained physician supervise this complete process, which may help to eliminate patients self-diagnosing themselves.

6. Primary Signs of Gluten Intolerance:

Celiac disease is frequently mistaken with gluten intolerance or wheat-related allergy. All three conditions are separate and do not have any relevance. Celiac disease can damage the digestive system, gastrointestinal, or GI tract which are at times also known to be an autoimmune disease. Wherein gluten intolerance displays less severe symptoms than both celiac disease or wheat allergy. In fact, a wheat allergy may also be a destructive disease as some symptoms cause breathing problems and even loss of consciousness. Their symptoms might be similar in certain cases, but there is no history of their interrelation (8).

It is widely known that only one out a hundred people suffer from celiac disease when the worldwide statistics are taken into consideration. Gluten intolerance refers to the diseases triggered by gluten like celiac disease, non-celiac diseases, dermatitis herpetiformis (DH), and wheat allergy. However, due to lack of specification in similarities of these diseases doctor avoid using the term gluten intolerance. Gluten refers to the group of proteins like prolamins, and glutelins stored with starch in the Endosperm of various cereal (grass) grains (9).

Celiac disease is the most common chronic, immune-mediated disorders triggered by the increased consumption of gluten in the diet. A mixture of proteins found in wheat, barley, rye, and oats with their derivatives may cause reactions with the digestive system hindering to work properly. However, a celiac disease not only have environmental component included, but genetic components are also involved. This is because there is a presence of HLA (Human Leukocyte Antigen) type II, specifically DQ2 and DQ8 alleles of the human.

Patients diagnosed with celiac disease find it difficult to digest, leading to adverse problems in the digestive system. When the gluten-rich diet enters the small intestine of a celiac disease sufferer, his immune system attacks it. The small intestine stops working normally and chances of occurrence of inflammation rise. The small intestine becomes incapable of absorbing nutrients naturally. Moreover, chronical discomfort leads to malnutrition due to gut misregulation. In comparison to celiac disease, gluten involves mild and less damaging allergic reaction. Celiac disease causes severe immune system adverse reactions towards gluten. Therefore, it is strictly suggested to visit a doctor in case, any such symptoms are found. A regular checkup must also be performed to see the correct cause of disease or reaction.

The celiac blood vessel is additionally called as a celiac trunk. The abdominal aorta containing the celiac artery is the central and primary branch to nourish abdominal. Celiac artery is one of the three chief anterior branches of the abdominal aorta. The celiac artery works persistently to adequately supply oxygenated blood to the stomach, liver, spleen, and abdominal esophagus. It also nourishes the superior half of both duodenum and pancreas. Celiac artery is a rich and valuable source of supplying blood in the lower part of the body. It is the only artery (blood vessel), which nourishes the abdominal or gastric digestive organs. (10)

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