Celiac Sprue (cont.)
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Exams and Tests
The likelihood of celiac sprue determines the approach to diagnosis. If a low or moderate suspicion exists that celiac disease is present, a blood test fortissue transglutaminase (tTG) or antiendomysial antibody is performed. If the likelihood that someone has celiac disease is very high or the blood test result is positive, then biopsies of the small intestinalshould be performed.
Genetic testing is only performed in certain circumstances.
The best diagnostic tests for celiac sprue include measurements of antibody levels to endomysium and to an enzyme called tissue transglutaminase (tTG). The 2 tests are very specific for celiac disease in persons who are untreated.
Measurements of antibodies to gliadin and reticulin (a part of the cell structure) are other diagnostic tests that are less specific for celiac disease.
Small intestinal imaging tests
Radiology tests, such as small-bowel barium studies and abdominal/pelvic CT scanning, are usually not helpful in establishing the diagnosis of celiac disease. In video capsule endoscopy, a tiny camera in a capsule films the small intestine as the camera moves through it; however, this study cannot examine the tissue microscopically. These tests should be considered in the evaluation of persons with suspected celiac sprue and those who have dramatic weight loss, severe abdominal pain, intestinal bleeding, significant decrease in albumin levels, and intestinal obstruction. These symptoms may suggest the presence of tumors orulcers in the small intestine.
Small intestinal biopsy
The lining of the small intestine usually consists of fingerlike projections called villi. The villi contain digestive enzymes and provide the large absorptive surface of the small intestine. In celiac sprue, the villi are destroyed because of the inflammatory and autoimmune process. Once the villi are destroyed, nutrients cannot be absorbed. Biopsy samples of the small intestine show mild, moderate, or severe destruction of the villi depending on the severity of the inflammation. Biopsy samples of the small intestine are obtained by introducing a small, flexible endoscope through the mouth, the stomach, and into the small intestine while the patient is sedated.
Mohammed Wehbi, MD
Vincent W Yang, MD, PhD
Robin E Rutherford, MD
Simmy Bank, MD, MB, ChB
Mary L Windle, PharmD
BS Anand, MD
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