What are the tests for coeliac disease?

Tuesday, 22 December 2020 / Published in Other
What are the tests for coeliac disease?

The diagnosis of celiac disease involves the patient’s history and objective observation, the search for specific antibodies and autoantibodies in his blood, the execution of the sorbitol breath test, the examination of the stool, and, ultimately, the standard gold examination: the duodenal biopsy.
In the preliminary phase the doctor tries to highlight the typical symptoms of coeliac disease, essentially of gastrointestinal origin and include dyspepsia, diarrhea or constipation, malaise, flatulence and abdominal distension, but in an advanced stage there are malnutrition: low stature in children, pubertal retardation, weight loss, iron deficiency and folate anemia, vitamin deficits, osteoporosis and osteomalacia.However this pathology has various and heterogeneous symptoms that can present in a severe or extremely nuanced.
Among the first tests we evaluate the blood dosage of particular antibodies and autoantibodies, such as anti-tissue transglutaminase, anti-endomisis antibodies and antigliadine antibodies .
If the levels of these antibodies appear above the norm, the patient is probably celiac and therefore eligible for further investigation. Patients with high titers of anti-tissue transglutaminase antibodies and anti-endomysium antibodies are more than 95% likely to be celiac.
Then we could continue with the Sorbitol Breath Test, a diagnostic test particularly useful in the screening phase of coeliac disease.
Five grams of sorbitol is administered to the patient and the concentration of hydrogen in the expired air is measured at regular intervals. If this increases it means that sorbitol has escaped absorption in the small intestine and has been fermented by the bacterial flora of the colon, with production of intestinal gas including hydrogen.
A positivity to the sorbitol breath test indicates therefore a problem of intestinal malabsorption, common among the celiac subjects but also to other diseases, for example in case of pancreatic insufficiency, syndrome from bacterial contamination of the tenuous, short bowel syndrome and Crohn’s disease.
The examination that leaves less room for methodological errors and interpretation of the results is, however, the duodenal biopsy.  It is an invasive examination, performed on subjects positive to previous tests to obtain diagnostic confirmation of celiac disease.
The examination is performed by esophageastroduodenoscopy, during which a long and thin flexible tube is inserted through the oral cavity and lowered along the esophagus to the stomach and the first tract of the intestine. This instrument is equipped with a camera with a light source and through the tube can be made to slide micro-surgical instruments to withdraw small samples of the intestinal mucosa, subsequently observed in the laboratory.

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