How do they test for Celiac?

There are two ways to diagnose celiac-

1. A blood test that looks for antibodies to gluten
2. An intestinal biopsy looking for damage to the intestine caused by celiac

Most of the time, the antibody test and the patient history are the means of diagnosis. A biopsy is rarely done.

 

while it's true that the blood test is often done first - as a sort of screening tool - in reality the only way to ensure a 100% accurate diagnosis is to have a biopsy. while the blood test (for the antibodies) can certainly be a helpful tool in the process of diagnosis it can have both false negatives and false positives. in other words some people will have a positive blood test but not actually have celiac disease (known as a false positive) while others can have a negative blood test (aka no antibodies detected) but still have full fledged celiac disease. so in the end a biopsy is the only guaranteed means of diagnosis. the biopsy of the intestinal mucosa (inside lining of the small intestines) is done during an endoscopy which, if you don't already know, is essentially a tube that's put down your throat while you're lightly sedated. the tube allows for various things to be passed into your stomach & small intestines (camera, tools to take a biopsy, etc.) to help with the diagnosis (and occasionally even treatment) of various GI issues. the procedure is almost always outpatient (pretty much always unless someone has a complicated underlying health situation) and not bad at all in the big scheme of things.

all of that being said, unless someone is having symptoms or has a positive blood test &/or family history a biopsy (and thus an endoscopy) would rarely be done.

a few other things to note:

make sure your diet includes gluten when you undergo testing of any type or else you may not get accurate results. this does NOT mean you need to go on a gluten binge; it simply means that you generally shouldn't restrict your gluten intake prior to testing.

there are a fair number of individuals who do not technically have celiac disease but still seem to have varying degrees of sensitivity to gluten or wheat (or other allergens for that matter, i.e. lactose, casein, etc.) in most cases it is advisable to do the official testing for celiac first (if you have reason to do so; i'm not trying to suggest that every single person needs to be doing this in the least) and then - if results of both bloodwork AND biopsy are negative while one's diet has included gluten - consider the possibility of gluten sensitivity. while no definitive testing exists for diagnosis there are a good number of individuals who report improved health upon eliminating (or simply reducing) gluten from their diets. this "improved health" ranges from improvements in GI-related complaints to more systemic benefits (i.e. better sleep, more energy, fewer aches & pains, less symptoms of an underlying illness, etc.) and is most often something that can only be explored via dietary elimination of gluten, wheat, or any other suspected aggravator. some people with resistant health frustrations find an "elimination diet" to be helpful though it is quite a commitment; a search online will give you more info on this (and i'm sure many other things!) if you do decide to experiment on your own w/ eliminating gluten &/or wheat products just remember to wait until AFTER you've had any testing done for celiac disease. and/or if you have already eliminated items from your diet &/or choose to do so prior to pursuing testing just make sure that you reintroduce a decent amount of gluten-containing products into your diet for at least a few weeks prior to testing; adding them in only a day or two in advance will not always be enough to elicit an accurate test result.

hope this helps!
melissa