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Exploring Celiac Disease

Celiac disease affects more than 2 million people in the U.S., yet only around 30% of cases are currently diagnosed.1,2 Diagnosing your patients with celiac disease can be challenging due to the wide range of symptoms and age of onset. Extraintestinal symptoms may be more prevalent than gastrointestinal symptoms, and subclinical celiac disease accounts for about 30% of new cases.1 Labcorp offers a full range of testing services to support you in the evaluation for and management of celiac disease.

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Find more information about our celiac disease testing
 

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Current Celiac Testing Options

We help you diagnose or rule out celiac disease through our comprehensive menu of celiac antibody and genetic (HLA) tests. We also provide a quantitative test for gluten in stool samples to help monitor adherence to a gluten-free diet.

Multiple celiac profile and individual test choices are available to fit the needs of patients and family members, whether they are on a regular or gluten-free diet. For children younger than 2 years of age, the antibody profile recommended is 164010.5

Our Celiac HLA testing is comprehensive, reporting on DQ2, DQ8, and half DQ2, in addition to genetic risk.

The Celiac HLA Association Reflex to Antibodies profile provides both genetic and antibody results in one test order.

For patients on diets containing gluten
 

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For patients on a gluten-free diet 
 

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Negative HLA DQ essentially excludes celiac disease.1,2 See Labcorp Directory of Services for alternative testing when celiac is ruled out. 

Patients on a gluten-free diet may have positive celiac antibody results depending on the length of time on the diet and adherence (Rubio-Tapia). Approximately 80% of patients test negative for celiac antibodies after 6-12 months of adherence to a gluten-free diet (Rubio-Tapia). Negative antibody results are inconclusive if the patient has been on a gluten-free diet for more than two weeks.

Gluten-free diet adherence assessment by testing for gluten in stool samples. (white paper in eDOS for test 123027) 

Genetic counseling services are available at 800-533-1037 (revise the number to HLA Customer Services number)

The benefits of genetic testing options for celiac disease

  • Genetic results are unaffected by a gluten-free diet
  • Celiac genetic testing is only needed once in a lifetime
  • A positive result (HLA DQ2, DQ8, or half DQ2) reveals genetic predisposition to celiac disease
  • A negative result essentially excludes celiac disease

Celiac genetic testing is most useful in the following circumstances5,7:

  • For patients (symptomatic or asymptomatic) with a confirmed case of celiac disease in a first-degree relative – for celiac risk assessment
  • To examine suspicion of celiac disease in patients on a gluten free diet – to rule out celiac disease or confirm predisposition
  • To rule out celiac disease in patients with ambiguous antibody or small bowel biopsy results or discrepancy between those results

We have two options for celiac genetic testing: HLA DQ alone (test code: 167082) HLA DQ with reflex to celiac antibodies: If celiac HLA results are positive, testing reflexes to celiac antibodies (test code: 164019) Genetic counseling services are available at 800-533-1037 (revise number)

References:

  1. Hujoel IA, Reilly NR, Rubio-Tapia A. Celiac Disease: Clinical Features and Diagnosis. Gastroenterol Clin North Am 2019 Mar;48(1):19-17.
  2. Choung RS, Unalp-Arida A, Ruhl CE, Brantner TL, Everhart JE, Murray JA. Less hidden celiac disease but increased gluten avoidance in the USA: Findings from the National Health and Nutrition Examination Surveys from 2009 – 2014. Mayo Clin Proc 2016 Dec 5:S0025-6196(16)30634. doi: 10.1016/j.mayocp.2016.10.012. Online ahead of print.
  3. Taylor AK, Lebwohl B, Snyder CL, Green PHR. Celiac Disease. In: Adam MP, Feldman J, Mirzaa GM, et al., eds. GeneReviews®. Seattle (WA): University of Washington, Seattle; July 3, 2008.
  4. Nellikkal SS, Hafed Y, Larsen JJ, Murray JA, Absah I. High prevalence of celiac disease among screened first-degree relatives. Mayo Clin Proc. 2019 Sep;94(9):1807-1813.
  5. Rubio-Tapia A, Hill ID, Samrad C, Kelly CP, Greer KB, Limketkai BN, Lebwohl B. American College of Gastroenterology Guidelines Update: Diagnosis and management of celiac disease. Am J Gastroenterol. 2023 Jan 1;118(1):59-76.
  6. Hill ID, Fasano A, Guandalini S, Hoffenberg E, Levy J, Reilly N, Verma R. NASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten-Related Disorders. JPGN. 2016;63:156-165.
  7. Brown K, Guandalini A, Semrad C and Kupfer SS. A clinician’s guide to celiac disease HLA genetics. Am J Gastroenterol. 2019; Oct;114(10):1587- 1592.