Intestinal biopsy is not always required to diagnose celiac disease (CD): a retrospective analysis of combined antibody tests published (23 January 2013) in the article at BMC Gastroenterology 2013, 13:19. Author: Hadziselimovic Faruk

The retrospective study included sera (plural of serum) from 149 CD patients and 119 controls, all with intestinal biopsy. All samples were analyzed for IgA and IgG antibodies against native gliadin (ngli) and deamidated gliadin peptides (dpgli), as well as for IgA antibodies against tissue transglutaminase and endomysium.

Antibody tests for dpgli yielded superior results compared with ngli. A combination of three or four antibody tests including IgA anti-tissue transglutaminase and/or IgA anti- endomysium permitted diagnosis or exclusion of CD without intestinal biopsy in a high proportion of patients (78%). Jejunal biopsy would be necessary in patients with discordant antibody results (22%). With this two-step procedure, only patients with no CD-specific antibodies would be missed.

What is Celiac Disease?

A chronic nutritional disturbance, usually of young children, caused by the inability to metabolize gluten, which results in malnutrition, a distended abdomen, muscle wasting, and the passage of stools having a high fat content. The disorder can be controlled by a special diet that emphasizes the elimination of all foods containing gluten.

Note: Feces float due to either air/gast or fat content.  Gluten is a protein found in wheat, barley, and rye.

Information on Antibodies

An immunoglobulins test is done to measure the level of immunoglobulins, also known as antibodies, in your blood.

Antibodies are substances made by the body’s immune system in response to bacteria, viruses, fungus, animal dander, or cancer cells.  Antibodies attach to the foreign substances so the immune system can destroy them. See a picture of the immune system.

Antibodies are specific to each type of foreign substance. For example, antibodies made in response to a tuberculosis infection attach only to tuberculosis bacteria. Antibodies also work in allergic reactions. Occasionally, antibodies may be made against your own tissues. This is called an autoimmune disease.



If your immune system makes low levels of antibodies, you may have a higher chance of developing repeated infections. You can be born with an immune system that makes low levels of antibodies, or your system may make low levels of antibodies in response to certain diseases, such as cancer.


The five major types of antibodies are:

  • IgA. IgA antibodies are found in areas of the body such the nose, breathing passages, digestive tract, ears, eyes, and vagina. IgA antibodies protect body surfaces that are exposed to outside foreign substances. This type of antibody is also found in saliva, tears, and blood. About 10% to 15% of the antibodies present in the body are IgA antibodies. A small number of people do not make IgA antibodies.
  • IgG. IgG antibodies are found in all body fluids. They are the smallest but most common antibody (75% to 80%) of all the antibodies in the body. IgG antibodies are very important in fighting bacterial and viral infections. IgG antibodies are the only type of antibody that can cross the placenta in a pregnant woman to help protect her baby (fetus).
  • IgM. IgM antibodies are the largest antibody. They are found in blood and lymph fluid and are the first type of antibody made in response to an infection. They also cause other immune system cells to destroy foreign substances. IgM antibodies are about 5% to 10% of all the antibodies in the body.
  • IgE. IgE antibodies are found in the lungs, skin, and mucous membranes. They cause the body to react against foreign substances such as pollen, fungus spores, and animal dander. They may occur in allergic reactions to milk, some medicines, and some poisons. IgE antibody levels are often high in people with allergies.
  • IgD. IgD antibodies are found in small amounts in the tissues that line the belly or chest. How they work is not clear.

The levels of each type of antibody can give your doctor information about the cause of a medical problem.

What is endomysium?

The endomysium is a layer of connective tissue that ensheaths a muscle fiber. The endomysium contains a form of transglutaminase called “tissue transglutaminase” or “tTG” for short, and antibodies that bind to this form of transglutaminase are called anti-endomysial antibodies (EMA). The antiendomysial antibody test is a histological assay for patient serum binding to esophageal tissue from primate. EMA are present in celiac disease. They do not cause any direct symptoms to muscles, but detection of EMA is useful in the diagnosis of the disease.

Safe Replacement Flours and Starches for Gluten Free Diet

Grains flours/ starches

Legume flours

Seed flours

Tuber flours/ starches

Nut flours

  • Rice
  • Corn
  • Sorghum
  • Soy
  • Chickpeas
  • Fava bean
  • Peanut
  • Flaxseed
  • Millet
  • Buckwheat
  • Amaranth
  • Quinoa
  • Potato
  • Tapioca
  • Arrowroot
  • Sweet potato
  • Chestnut
  • Almond
  • Walnut
  • Filbert