Celiac disease: Pathogenesis and serologic tests

The serological tests represent a significant advance in screening at-risk patients for celiac disease and probably should supplant other nonspecific methods for screening, such as 72-hr fecal fat, the d-xylose test, serum carotene, or small-bowel x-ray. The latter tests lack sensitivity, specificity, or simplicity. The published results suggest that the EMA IgA IFA is currently the screening tool of choice. The demonstration of the characteristic histological abnormalities of the intestinal abnormality and clinical improvement on a gluten-free diet is the gold standard for the diagnosis of celiac disease. Whether serological testing can substitute for intestinal biopsy in the diagnosis of celiac disease will depend on the experience obtained from more widespread application of these tests. The greater availability and more frequent use of these tests should increase the detection of a readily treatable condition, the diagnosis of which is often greatly delayed.