No problem.... this all gets quite confusing in regard to testing... partly because no test is perfect!
Here is a good thing to take to your doctor, as it comes straight from the celiac center at Maryland, run by Dr. Fasano, a leader in celiac research.
The University of Maryland Center for Celiac Research still includes the antigliadin IgA and IgG tests. If your doctor doesn't want to include them... here is your best source! Dr. Fasano, who heads this center, is world reknown for his work with celiac disease.
Quote:
What are the recommended blood tests to diagnose CD? There is a particular series of blood tests called the ‘Celiac Panel”. These tests measure your immune system’s response to gluten in the food you eat.
tTG-IgA or tissue transglutaminase-IgA
AGA-IgG or Antigliadin IgG
AGA-IgA or Antigliadin IGA
Total IGA
The presence of tTG antibodies is highly suggestive of CD, while AGA can be elevated also in cases of wheat allergy.
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Is the "anti-gliadin antibodies" one of the ones listed in the quote below?
YES. Antigliadin IgA, IgG
Do I need all 4 tests listed below done?
YES!!!!! Some doctors will reduce it to the single anti-tTG case which is much more specific to celiac disease. A positive result is almost a sure bet that they would find intestinal damage on biopsy. However, particularly when neurological disease is involved, the antigliadin antibodies may bear more meaning. They are an indicator of gluten sensitivity, and you can have gluten sensitive neurological disease without having celiac disease (villous atrophy on intestinal biopsy)
Is one of the ones listed below the "small intestine biopsy"? From what I've read the biopsy is done later to confirm intolerance, right?
If someone has a positive result on the antibody tests above, then they will generally follow up with an intestinal biopsy, take samples, and look for villous atrophy microscopically.
What is better... the stool test or the blood test? Well, that is a matter of opinion.
My opinion is that everyone should BEGIN with the traditional standard testing above. These are standard of care/mainstream tests and no doctor is going to dispute the results. They may disagree about what the results mean, but the tests themselves are standard.
However, thousands of people test negative to these blood tests, but will test positive to the stool test developed by Dr. Kenneth Fine. I've had the pleasure of attending a lecture by Dr. Fine, and he is certainly ahead of the pack in realizing that gluten sensitivity can affect one from head to toe, without testing positive for celiac disease. You can check his curriculum vitae on the Enterolab website and you will find he is a qualified MD with many published research articles. So far, he has not published anything regarding his stool testing, which his critics are quick to point out. He looks for antibodies in the stool, at the source of the reaction, and says they can be found there long before they reach the blood stream. I've known many many people who have gone gluten free based on the results of the stool test, and they never look back. The traditional testing is really focused on celiac disease. The stool testing does not diagnose celiac disease, but gluten sensitivity.
Even the celiac disease experts will acknowledge there are cases of seronegative celiac disease, so if we rely soley on blood tests... some will be missed.
And, Dr. H. in the UK has shown us that gluten sensitivity can cause gluten ataxia in patients with no villous atrophy on intestinal biopsy. If we rely only on biopsy results, some will be missed.
My personal is opinion is that people should begin with the traditional tests, but not take "negative" results as 100% conclusive. A follow up stool test may show gluten sensitivity.
There is an argument that can be made for just starting with the most sensitive test, the stool test. I just think that if someone is lucky enough to get a positive result on the traditional testing, it is worth having, as it holds up better in your doctor's office. While many more physicians are utilitzing Enterolab because they realize the shortcomings of traditional testing, it is still considered an "alternative" form of testing.
If someone doesn't have medical insurance, they should remember that you don't need a doctor's prescription or permission to make dietary changes. Sometimes, a dietary trial may be the best test of all. If someone can swing the testing, though, I think it makes sense to do it. And, particularly with neurological symptoms, it may take a long time to notice improvement (up to a year or more)... and some people want a little more to go on. Gastrointestinal symptoms usually respond within 3-6 months, at least some initial signs of improvement. My daughter was having neurological symptoms that did actually resolve within 3-6 months... it all really depends upon the type, severity, and duration of neurological symptoms prior to GFD.
I hope I've answered some of your questions. I do explain this in more detail in The Gluten File, if you want to take another pass at it.
Cara