What to do when one suspects coeliac disease?

A definitive diagnosis can only be given through a biopsy of the small intestine. During the biopsy tissue fragments are taken and examined histologically, in order to determine a potential villous atrophy.

Serological examinations can confirm the suspicion of coeliac disease. Here, first and foremost, the anti-transglutaminase-antibodies (ATA) of the category lgA are examined. This is an extremely reliable and routine blood test. Equally significant, but carried out as a secondary measure, is the determination of anti-endomysial antibodies (EMA). The anti-gliadine-antibodies (AGA) of the category lgA and lgG are especially significant with children under the age of 2, as they give a clearer result than the other antibodies. The isolated change of AGA-lgG alone is not decisive enough for a diagnosis, except for children with an lgA deficiency.

With positive serological results a biopsy of the small intestine is recommended, which is done through a gastroscopy. If there are positive serological results, as well as typical changes in the area of the small intestine (villous atrophy, increase of the antibodies in the mucous membrane of the small intestine), then the diagnosis of coeliac disease can be definitely confirmed.

Sometimes people start following a gluten-free diet for reasons like irritable bowel syndrome or personal choice before undergoing diagnostic tests for coeliac disease. In such uncertain cases where a diagnosis of coeliac disease cannot be confirmed without a doubt, it is only confirmed when re-exposure to gluten leads to clinical and biopsy relapse within a few months (rarely years later). The medical supervision should be strictly followed during gluten re-exposure.