Intestinal Biopsy no longer required for Celiac Diagnosis.

Villi under an electron microscope  © 2011 S. Schuller, Wellcome Images, used under Creative Commons license.
Villi under an electron microscope © 2011 S. Schuller, Wellcome Images, used under Creative Commons license.
Published today in the BMC Gastroenterology, finally a conclusion that might help people get to an understanding of their reaction.

This review study gathered information from 40 different studies, all looking to see whether the invasive biopsy is truly necessary for celiac diagnosis.

Their conclusion?

“There is no single test — not even jejunal biopsy — that can conclusively diagnose or exclude CD in every individual. Therefore, we propose the following two-step diagnostic procedure: The first step is the combined, simultaneous determination of IgA anti-dpgli and IgG anti-dpgli + IgA anti-tTG and/or EMA. The vast majority of patients will have either three positive or three negative results, obviating the need for a biopsy. The second step, jejunal biopsy, should be performed only in patients with discordant antibody results (i.e., in patients whose CD status cannot be classified by antibody tests alone). In any case, effects of a gluten-free diet must be controlled.”

Take Home Message:Celiac Diagnosis

If you have symptoms, or first degree relatives who have celiac disease, convince your doctor to run a complete celiac blood panel to see. The needed tests are IgG anti-dpgli + IgA anti-dpgli + IgA anti-tTG. No longer is the anti endomysial antibody considered essential for diagnosis.

For all the Geeky folks like me, here is the original research and citation


  1. Sarah says

    Hi Jean,

    Can you explain this a bit more for me? I had the regular blood test twice over a period of five years when I was eating gluten and each time it was negative for Celiac disease. Both doctors never followed up with a biopsy. However, now that I’m gluten free, I feel amazing.

    I know it’s revisionist of me to bring this up but was there a test that could have given me a Celiac diagnosis?


    • says

      Hi Sarah,
      do you still have the results of the tests? Frequently the range was interpreted very narrowly in the past. It’d be good to bring them back to a doctor now.

  2. says

    Finally! Someone is clarifying this. I never had a biopsy but was diagnosed with celiac because my doctor was able to read my blood results and DNA results to see I carried both genes and problems resolved with gluten-free diet.