Type of test Blood

 Normal findings

Test explanation and related physiology

Gliadin and gluten are proteins found in wheat and wheat products. Patients with celiac disease cannot tolerate ingestion of these proteins or any products containing wheat. When an affected patient ingests wheat-containing foods, gluten and gliadin build up in the intestinal mucosa. These gliadin and gluten proteins (and their metabolites) cause direct mucosal damage.

Furthermore, IgA immunoglobulins (antigliadin, anti endomysial, and antitissue transglutaminase [tTG-ab]) are made, appearing in the gut mucosa and in the serum of severely affected patients. The identification of these antibodies in the blood of patients with malabsorption is helpful in supporting the diagnosis of celiac sprue or dermatitis herpetiformis. However, a definitive diagnosis of celiac disease can be made only when a patient with malabsorption is found to have the pathologic intestinal lesions characteristic of celiac disease. Also, the patient’s symptoms must be improved with a gluten-free diet. Both are needed for the diagnosis. Because of the high specificity of IgA endomysial anti bodies for celiac disease, the test may obviate the need for multiple small bowel biopsies to verify the diagnosis.

In patients with known celiac disease, these antibodies can be used to monitor disease status and dietary compliance. Furthermore, these antibodies identify successful treatment because they will become negative in patients on a gluten-free diet.

Interfering factors

 • Other GI diseases (e.g., Crohn disease, colitis, and severe lactose intolerance) can cause elevated gliadin antibodies.

Procedure and patient care

• See inside front cover for Routine Blood Testing.

 • Fasting: no

 • Blood tube commonly used: red

 • Obtain a list of foods that have been ingested in the last 48 hours.

 • Assess how many malabsorption symptoms the patient has been experiencing in the last few weeks.

Abnormal findings

- Celiac disease

- Celiac sprue

 - Dermatitis herpetiformis

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