Information about
CELIAC
WHY screen for celiac disease?
HOW do I screen for celiac disease?
Result: Screened NEGATIVE
Result: Screened POSITIVE
WHY screen for celiac disease?
Along with type 1 diabetes, celiac disease is one of the most common autoimmune diseases. Celiac disease is often diagnosed late because symptoms can be hard to recognize. People with celiac disease cannot eat gluten. Gluten is found in most cereals, breads and pastas. It is also hidden in many other foods like vinegar, soup, soy sauce, and even some ice cream. When a person with celiac disease eats gluten, it triggers inflammation in the intestines. Even if there are no symptoms, there can be serious risks of poor growth, weakened bones and increased risk of intestinal cancer.
Gastrointestinal symptoms of celiac disease include:
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Poor growth
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Poor weight gain or weight loss
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Stomach aches, being gassy or bloated
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Chronic diarrhea, vomiting, constipation
There are also many non-gastrointestinal symptoms such as joint pains, headaches, brain fog, and rash. People can still develop celiac disease without having any noticeable symptoms or even without having other family members with celiac disease.
Screening for celiac disease allows for early treatment with a gluten-free diet that can prevent symptoms and complications of celiac disease. A gluten-free diet should only be adopted after a diagnosis is confirmed and with the guidance of a gastroenterologist and dietitian. Going gluten-free before confirming a diagnosis can make interpretation of tests and diagnosis impossible.
HOW do I screen for celiac disease?
Screening is done with a simple blood test that checks for one of the celiac antibodies, tissue transglutaminase (tTG) IgA.
NOTE TO PROVIDERS: A total IgA level should be sent as well. The total IgA does not screen for celiac disease, but instead ensures that the tTG IgA is the right test to send for screening. If the total IgA level is low, the tTG IgA can be falsely negative.
Result: Screened NEGATIVE
If the screening test does not show any of the blood markers of celiac disease and total IgA is normal, celiac disease is unlikely. This does not mean that a person will never develop celiac disease as these blood markers may develop in the future, but they are less likely to develop after the age of 10 years.
Celiac disease can occur in people who don’t experience symptoms. However, typical signs of celiac disease are listed below:
Typical Signs of Celiac Disease
✓ Frequent stomach aches, being gassy or bloated
✓ Chronic diarrhea (more than 3 stools per day) OR
✓ Chronic constipation (less than 3 stools per week)
✓ Poor growth (in the past years)
✓ Weight loss or no weight gain
✓ Vomiting (not associated with illness)
✓ Low energy, feeling tired
✓ Itchy skin rash (elbows, knees)
✓ Low energy, feeling tired
✓ Headaches, brain fog
Should you develop any of these symptoms, we recommend repeating the blood test.
Celiac disease can occur in people who don’t have it in the family. However, there are specific groups of children at higher risk of celiac disease that warrant periodic screening including:
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Children with a family history of celiac disease
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Children with other autoimmune diseases (type 1 diabetes, thyroid disease, arthritis, autoimmune hepatitis)
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Children with genetic syndromes (Trisomy 21, Noonan syndrome, Williams syndrome)
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Children with selective IgA deficiency
If a child is in one of these groups, they should have screening repeated according to current disease specific clinical care guidelines.
Result: Screened POSITIVE
When a screening test is positive or above normal for the celiac autoantibody (tTGA), a person is at risk of having celiac disease, but does not confirm the diagnosis. This test should be repeated in a clinical lab.
Below are general recommendations based on the level of elevation of this test. However, these recommendations are not absolute and even with lower tTG IgA levels, people may still have celiac disease.
Additional testing by a gastroenterologist is required to make a diagnosis of celiac disease. If symptoms are present, the referral should be urgent. Until seeing a gastroenterologist, it is very important to stay on a gluten containing diet because starting a gluten-free diet too soon makes further diagnostic testing very difficult.
It is important to confirm the diagnosis through your doctor since the necessary treatment is a strict lifelong gluten-free diet. Being on a balanced and healthy gluten-free diet and avoiding all the hidden sources of gluten can be very difficult, which is why we recommend a consultation with a gastroenterologist and dietitian prior to starting a gluten free diet. At the appointment with a gastroenterologist, diagnostic steps will be discussed which may include endoscopy or consideration of diagnosis by labs alone based on test results.
For more information and resources on celiac disease, please visit:
Colorado Center for Celiac Disease (at Children's Hospital Colorado)
NEXT STEPS:
If you have questions about:
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Interpreting screening results; or
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Determining a follow-up plan after receiving results; or
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Screening for type 1 diabetes or celiac
Please e-mail us at Questions@ASKhealth.org or call us at 303-724-7983 and a member of Ask the Experts will reach out to you.