If there is no gluten intake, tTG starts to decline within months but may take 2 years to normalize.
A strict gluten free diet must be maintained thereafter so that tTG continues to remain within the normal range.
No, a normal tTG would only imply that the disease is under control and the level of antibodies has normalized. But a small amount of gluten intake will again elevate the level of antibodies and the tTG count.
A regular gluten containing diet for 8-12 weeks (for e.g. 2 wheat rotis/2 breads per day) prior to biopsy is needed to obtain accurate results.
No, if the diagnosis was based on a biopsy and the individual is doing well on a gluten free diet, there is no need to repeat the biopsy.
However, one should visit the doctor for follow-up on a yearly basis. Read more
In cases where gluten is eliminated from the diet without performing the biopsy, the following scenarios can occur:
There have been recent guidelines by some international associations involving the diagnosis of CD based on a combination of blood tests, under certain defined circumstances. This is being debated internationally. In India, no scientific body suggests that we skip the biopsy and diagnose based on blood tests alone (Read the question – What is the harm if biopsy is not performed before confirming the diagnosis).
As there is a lifelong modification of diet involved, it is extremely critical to be certain of the diagnosis before initiating the diet change. There may be instances where tTG is positive but the individual does not have celiac disease or tTG is falsely elevated; i.e., it is present but there is no celiac disease and hence there is no need to go on a gluten free diet. Additionally, in a study conducted by University of Chicago Celiac Disease Center, 10% patients were diagnosed with a different disease at the time of endoscopy and biopsy.
It is important to keep in mind that getting the blood test done at a reliable center is an important aspect but with a high incidence of gastrointestinal infections including giardia in our country, false positive results are common. Also we need to consider the possibility of potential celiac disease.
At present, we recommend biopsy in all cases where celiac disease is suspected.
No. Though the serology is good with a high sensitivity but if the suspicion is strong (signs and symptoms or positive family history), then the biopsy must be done regardless of the negative serology because both false positive and false negative tests are known to occur. Biopsy remains the gold standard. On the other hand, a negative ‘genetic’ study (absence of HLA DQ2 and HLA DQ 8) virtually rules out the possibility of celiac disease.
The result of biopsy will be inaccurate if there has not been any gluten consumption for a considerable amount of time in the diet, prior to the biopsy (This period is not defined and hence it is recommended that the biopsy be done while the suspected patient is on gluten).
The individual along with her Gastroenterologist will need to decide what would be the best course of action. In some situations, gluten challenge (i.e. ingestion of gluten for 8-12 weeks period under close supervision of your doctor) and then performing the biopsy would be ideal.
The various possibilities in such a situation are:
It would be best to review all the reports including the biopsy slides and stay on a gluten containing diet till a diagnosis is made. Genetic study to look at the HLA markers and a repeat biopsy after a few months would be useful in arriving at a diagnosis.
It is a general recommendation by some expert bodies to repeat a biopsy for these children after they have been on a gluten free diet for 2 years. Another biopsy is recommended after a gluten challenge of 8-12 weeks.
This is recommended as histology of many conditions in this age group resembles celiac disease.
Biopsy is normally not required when an individual is doing well on gluten free diet.
However, in certain cases, when the diagnosis is not clear (typically happens when you stop gluten intake before the biopsy) or the response is not as expected, your doctor may consider repeating it. For children diagnosed before the age of 2 years, some experts recommend repeating the biopsy after 2 years and a repeat biospy (3rd) thereafter (See question above).
Endoscopy can be safely performed even in a newborn but in general, celiac disease rarely occurs below the age of one year. It takes the body at least 4-6 months to develop the intolerance after gluten consumption is initiated.
The biopsy is not required to be repeated for him if he fulfilled all the criteria at the time of diagnosis – symptoms, biospy and response to gluten free diet. He has to maintain a lifelong strict gluten free diet as celiac disease is a lifelong condition.
This would not be recommended by any expert body for several reasons as listed below:
Watch the video about endoscopy to know more.
The immediate family members should be tested as celiac disease is genetic and parents, siblings and children have a much higher probability of developing celiac disease than the general population. They should be screened at the time the index patient is diagnosed and thereafter, if they exhibit any symptoms, or at least annually. Early diagnosis can help prevent complications in them.