Navigating Celiac Disease Testing: A Comprehensive Guide for the UK
Doctor explains the steps involved in testing for celiac disease in the UK, from blood tests to biopsies, and offers insights into managing a gluten-free diet post-diagnosis.
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Topic Breakdown
So, you think you might have celiac disease? But what does the test involve? In this post, we're going to dive into how celiac disease is currently investigated, using information and resources from the United Kingdom. If you don't live in the UK, this process may differ depending on where you are.
Celiac disease is a condition where your immune system attacks your own tissues when you eat gluten. Gluten is a dietary protein found in three types of cereal: wheat, barley, and rye. This immune reaction damages your gut, specifically the small intestine, making it difficult for you to absorb nutrients. Celiac disease can cause a range of symptoms, including diarrhea, abdominal pain, and bloating. Gluten can be found in many foods that contain these cereals, including pasta, cakes, breakfast cereals, most types of bread, certain types of sauces, and some ready meals.
Currently, in the UK, testing for celiac disease involves two main steps: a blood test to identify potential celiac disease and a biopsy of the small intestine to confirm the diagnosis. While being tested, you should continue to eat foods containing gluten to ensure that the tests are accurate. This means consuming gluten in more than one meal a day for at least six weeks before testing. It's crucial not to start a gluten-free diet until a specialist confirms the diagnosis, even if the blood test results are positive.
Let's talk about the first test, which is the blood test. Your doctor will arrange a blood test to check for specific antibodies usually present in people with celiac disease. In the UK, the first-line test is serum immunoglobulin IgA tissue transglutaminase and total IgA. These are antibodies, also called immunoglobulins, which are proteins that recognize and eliminate germs. If celiac disease antibodies are found in your blood, your doctor will typically refer you for a biopsy of your intestine. Remember, it's crucial to include gluten in your diet when the blood test is being done because avoiding it could lead to an inaccurate result.
Sometimes, it's possible to have celiac disease without these antibodies in your blood. If you continue to have symptoms of celiac disease despite a negative blood test, your doctor may either repeat the blood test or still recommend a biopsy.
This brings us to the second part: the biopsy. A biopsy is the diagnostic test and is usually done in a hospital by a gastroenterologist, a doctor specializing in stomach and bowel conditions. A biopsy helps confirm the diagnosis of celiac disease. During the procedure, a thin, flexible tube with a light and camera at one end, called an endoscope, will be inserted into your mouth and passed down to your small intestine. Before the procedure, you'll be given a local anesthetic to numb your throat and perhaps a sedative to help you relax. The gastroenterologist will pass a tiny biopsy tool through the endoscope to take samples of the lining of your small intestine. These samples will then be examined under a microscope for signs of celiac disease.
Once the diagnosis is confirmed, you may have other tests to assess how celiac disease has affected you. These may include additional blood tests to check levels of iron and other vitamins and minerals in your blood. This helps determine whether celiac disease has caused problems such as iron deficiency anemia, which is a lack of iron in your blood due to poor nutrient absorption.
If you have dermatitis herpetiformis, an itchy rash associated with celiac disease, you may need a skin biopsy to confirm it. Often, this diagnosis can be made by a doctor simply looking at it in the clinic if they know you have celiac disease. If a biopsy is needed, it can be done under local anesthetic and involves taking a small skin sample from the affected area for examination under a microscope.
You may also need a DEXA scan if your doctor thinks your condition may have affected your bones. In celiac disease, poor nutrient absorption can make bones weak and brittle, a condition known as osteoporosis. A DEXA scan is a special type of X-ray that measures bone density to determine if you're at risk of bone fractures as you age.
Many people feel overwhelmed when they're first diagnosed with celiac disease. Switching to a gluten-free diet can be confusing, especially if you've been eating foods containing gluten for many years. In the first few months after diagnosis, many people accidentally consume foods containing gluten, which may trigger a return of symptoms.
You can learn more about celiac disease and receive practical advice about following a gluten-free diet from your local celiac disease support group. In the UK, the Coeliac UK website provides information and advice about celiac disease, plus details of support groups in your area. I've included that link in the description box of the video, so please do check that out. I've also included further resources and reading in the description box, including links to helpful websites with lots more information about celiac disease.
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