{"id":5065,"date":"2013-05-24T15:44:48","date_gmt":"2013-05-24T15:44:48","guid":{"rendered":"http:\/\/health.glutenfreeworks.com\/?p=5065"},"modified":"2020-07-11T10:43:13","modified_gmt":"2020-07-11T14:43:13","slug":"diagnosis-and-testing","status":"publish","type":"post","link":"https:\/\/glutenfreeworks.com\/health\/diagnosis-and-testing\/","title":{"rendered":"Diagnosis and Testing"},"content":{"rendered":"<h2><a href=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/0002623926YY-849x565.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-9036\" src=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/0002623926YY-849x565-300x199.jpg\" alt=\"gluten sensitivity celiac disease diagnosis\" width=\"300\" height=\"199\" srcset=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/0002623926YY-849x565-300x199.jpg 300w, https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/0002623926YY-849x565.jpg 848w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a>How Is Celiac Disease Diagnosed?<\/h2>\n<p style=\"text-align: justify;\">Diagnosing Celiac Disease can be difficult and frustrating for both the patient and the doctor because each person is affected individually. With no definite set of symptoms to cause suspicion,\u00a0the single most important step in getting a diagnosis of\u00a0Celiac Disease is\u00a0to recognize its myriad\u00a0features.<a href=\"#footnote_1_5065\" id=\"identifier_1_5065\" class=\"footnote-link footnote-identifier-link\" title=\"National Institutes&nbsp;of Health, &rdquo;National Institutes of Health Concensus Development Conference&nbsp;Statement, Celiac Disease,&rdquo; August 9, 2004;1-14.\">1<\/a><\/p>\n<p style=\"text-align: justify;\">People who have any of the following situations should be evaluated for Celiac Disease:<\/p>\n<p style=\"text-align: justify;\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<ul class=\"cp_check blue\">\n<li>Symptoms indicating nutritional deficiencies.<\/li>\n<li>Unexplained digestive problems such as\u00a0IBS, acid reflux, diarrhea\/constipation, bloating, chronic abdominal pain.<\/li>\n<li>Chronic\u00a0skin disorders, especially when itchy.<\/li>\n<li>Unexplained visual problems including poor night vision, dry eye, or cataracts.<\/li>\n<li>An auto-immune disease like Type 1 Diabetes Mellitus\u00a0or Sjogrens Syndrome.<\/li>\n<li>A\u00a0chronic disease like arthritis, migraine headache, or polyneuritis.<\/li>\n<li>A\u00a0relative who has Celiac Disease.<\/li>\n<li>A\u00a0relative who has Dermatitis Herpetiformis.<\/li>\n<li>Frequent or long bouts of colds,\u00a0bronchitis, and other respiratory infections.<\/li>\n<li>Long recuperation from illness or surgery.<\/li>\n<li>A\u00a0history of\u00a0tuberculosis. Non-Hodgkin&#8217;s lymphoma.<\/li>\n<li>Cancer, especially of the digestive tract.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">\n\t\t\t<\/div><\/div>\n<p style=\"text-align: justify;\">Very good diagnostic tests are available, but no one test can definitively diagnose or exclude Celiac Disease in every individual.<a href=\"#footnote_2_5065\" id=\"identifier_2_5065\" class=\"footnote-link footnote-identifier-link\" title=\"Murray, J. &rdquo;The Widening Spectrum of Celiac Disease.&rdquo;&nbsp;American Journal of Clinical Nutrition. Mar&nbsp;1999;69(3):354-365.\">2<\/a>\u00a0And, because all diagnostic tests look for harmful\u00a0effects of gluten,\u00a0you must be\u00a0eating\u00a0gluten in your diet when\u00a0any diagnostic test is performed.\u00a0Tests\u00a0may be inconclusive if you strictly eliminate\u00a0gluten for longer than two weeks.\u00a0 So if you think you may have Celiac Disease or feel better going without gluten for a week to 10 days, go get tested before continuing.<\/p>\n<h2>Steps to Celiac Disease Diagnosis<\/h2>\n<p><!--more--><\/p>\n<h3 style=\"text-align: justify;\">1.\u00a0Make Appointment with Your Doctor<\/h3>\n<p style=\"text-align: justify;\">When you visit your doctor,\u00a0think carefully upon questioning. If you do not understand\u00a0a question,\u00a0ask him to explain.\u00a0Give\u00a0an accurate history of all symptoms because seemingly irrelevant problems can be very meaningful.\u00a0Your\u00a0doctor will\u00a0want to examine you for evidence of nutritional deficiencies or other problems.<\/p>\n<h3>2.\u00a0Blood Testing<\/h3>\n<p style=\"text-align: justify;\">Your doctor will order the following blood tests to\u00a0detect if you\u00a0have\u00a0specific autoantibodies\u00a0for\u00a0Celiac Disease\u00a0circulating in your blood.<\/p>\n<table border=\"1\" width=\"80%\" align=\"center\" bgcolor=\"#ffd7ac\">\n<tbody>\n<tr>\n<td>\n<ul class=\"cp_bullet blue\">\n<li><strong>IgA Anti-Endomysium Antibody (EMA)<\/strong> tests for Immunoglobulin\u00a0A type\u00a0autoantibodies\u00a0that\u00a0attack endomysium (connective tissue).<\/li>\n<li><strong>IgA Anti-tissue Transglutaminase Antibody\u00a0(tTG-IgA, tTG-IgG)<\/strong> tests for\u00a0Immunoglobulin\u00a0A\u00a0autoantibodies\u00a0that\u00a0attack\u00a0transglutaminase (a tissue enzyme).<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\">The <strong>IgA Anti-Endomysium Antibody<\/strong> (EMA) test can detect antibodies in excess of 90% of people.\u00a0 This test is the most costly because the actual lab work requires human evaluation.<\/p>\n<p style=\"text-align: justify;\">The <strong>IgA Anti-tissue Transglutaminase Antibody<\/strong> (tTG-IgA, tTG-IgG) test is the newest\u00a0antibody test.\u00a0 It can detect antibodies in 98% of adults and 96% of children.\u00a0 The tTG analysis is performed by a computer so that it is less costly than the EMA test.<\/p>\n<p style=\"text-align: justify;\">Other blood testing involves the specific\u00a0immune reaction to the gliadin component of gluten. These\u00a0are inexpensive tests useful to screen for evidence of the abnormal presence of gliadin\u00a0in the body.<\/p>\n<table border=\"1\" width=\"80%\" align=\"center\" bgcolor=\"#ffd7ac\">\n<tbody>\n<tr>\n<td>\n<ul class=\"cp_bullet blue\">\n<li><strong>IGA Anti-Gliadin Antibody (AGA-IgA)<\/strong> tests for Immunoglobulin A type\u00a0antibodies that attack gliadin. (Gluten Sensitivity reaction)<\/li>\n<li><strong>IGG Anti-Gliadin Antibody (AGA-IgG<\/strong>) tests for Immunoglobulin G type\u00a0antibodies\u00a0that attack gliadin.\u00a0(Gluten Sensitivity reaction)<\/li>\n<li><strong>Deamidated Gliadin Antibody (DGA-IgA, DGA-IgG) <\/strong>tests for antibodies against deamidated (changed) gliadin.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\"><strong>Antigliadin (AGA)<\/strong> tests have lower sensitivity for detecting celiac disease (70 to 85%) and\u00a0distinguishing celiac disease (70 to 90%) than the EMA or tTG tests.\u00a0\u00a0However, they have a high sensitivity for gluten exposure resulting from increased intestinal permeability, a gluten sensitivity reaction.\u00a0\u00a0Both IgA-AGA and IgG-AGA are advised.<\/p>\n<p><strong>Blood Results of Antibody Testing.<\/strong><\/p>\n<ul class=\"cp_check black\">\n<li style=\"text-align: justify;\"><strong>Positive Antibody Results<\/strong>. The presence of\u00a0IgA antibodies for any antibody (tTG, EMA, AGA) demonstrate a short-term immune response, showing that gluten was ingested usually within two weeks preceding the test. The presence of IgG antibodies demonstrate long-term immune response, indicating ingestion of gluten in the six months to a year preceding the test.<\/li>\n<\/ul>\n<ul class=\"cp_check black\" style=\"text-align: justify;\">\n<li><strong>Negative Antibody Results<\/strong>. Blood tests that return negative results for both IgA and IgG antibodies would be\u00a0considered\u00a0negative, provided you have\u00a0been regularly eating food with gluten. Negative Antibody Results and Suggestive Symptoms. Three scenarios are possible.<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li style=\"text-align: justify;\">You\u00a0may have selective IgA deficiency, meaning you do not make these antibodies so they will always be negative.\u00a0 A &#8220;Serum IGA&#8221; blood test would detect this condition.<\/li>\n<li style=\"text-align: justify;\">The blood test itself may be a &#8220;false negative,&#8221; meaning the laboratory testing is defective. If this is suspected, the test could\u00a0be\u00a0repeated using a lab with better experience, an alternative blood test could be conducted, and\/or a small intestinal biopsy could be performed.<\/li>\n<li style=\"text-align: justify;\">You may not have Celiac Disease.<a href=\"#footnote_2_5065\" id=\"identifier_3_5065\" class=\"footnote-link footnote-identifier-link\" title=\"Murray, J. &rdquo;The Widening Spectrum of Celiac Disease.&rdquo;&nbsp;American Journal of Clinical Nutrition. Mar&nbsp;1999;69(3):354-365.\">2<\/a><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<h3>3.\u00a0Biopsy of the Proximal Small Bowel<\/h3>\n<p style=\"text-align: justify;\">If your blood tests suggest Celiac Disease, your doctor will want to know if\u00a0your intestinal villi are damaged. He will send you to a gastroenterologist (doctor who specializes in gastro-intestinal disorders) who can obtain biopsies\u00a0(tiny pieces of your intestinal lining) to check for villi damage.<\/p>\n<p style=\"text-align: justify;\">An endoscopy\u00a0procedure is useful for actually looking at the esophagus, stomach, and first part of the small intestine. The gastroenterologist\u00a0passes an endoscope (a thin, lighted\u00a0tube) through the mouth and down the throat, while viewing the images on screen. Although\u00a0this procedure\u00a0is painless, it is difficult for\u00a0 patients to cooperate. Most people benefit by light sedation.<\/p>\n<p style=\"text-align: justify;\">It is not helpful to have an endoscopic evaluation <strong>without biopsies<\/strong>. Only\u00a0biopsies can confirm or exclude a diagnosis of Celiac Disease. Multiple biopsies should be obtained because the cell changes may be spotty.<a href=\"#footnote_2_5065\" id=\"identifier_4_5065\" class=\"footnote-link footnote-identifier-link\" title=\"Murray, J. &rdquo;The Widening Spectrum of Celiac Disease.&rdquo;&nbsp;American Journal of Clinical Nutrition. Mar&nbsp;1999;69(3):354-365.\">2<\/a><\/p>\n<p style=\"text-align: justify;\">Celiac Disease is the most common disorder that a gastroenterologist\u00a0would see.<a href=\"#footnote_3_5065\" id=\"identifier_5_5065\" class=\"footnote-link footnote-identifier-link\" title=\"Horvath K. &rdquo;Comments on Celiac Screening Test.&rdquo; Pediatric Gastroenterology and Nutrition&nbsp;Laboratory, UMAB\/Bressler Research Building,&nbsp;Room 10-047, 655 West Baltimore Street, Baltimore,&nbsp;MD. 21201.\">3<\/a><\/p>\n<p style=\"text-align: justify;\">Nevertheless, it has been demonstrated that among diverse endoscopy sites, gastroenterologists do not perform small bowel biopsy for the majority of patients with anemia, iron deficiency, weight loss, and diarrhea (classic symptoms of Celiac Disease).<a href=\"#footnote_4_5065\" id=\"identifier_6_5065\" class=\"footnote-link footnote-identifier-link\" title=\"Harewood GC, Holub JL, Lieberman DA. &rdquo;Variation in&nbsp;small bowel biopsy performance among diverse endoscopy&nbsp;settings: results from a national endoscopic database.&rdquo;&nbsp;American Journal of&nbsp;Gastroenterology.&rdquo; Sep 2004;99(9):1790-4.\">4<\/a><\/p>\n<p style=\"text-align: justify;\">This means you need to <strong>make certain<\/strong> that the doctor will take samples for biopsy.<\/p>\n<h4>Upper Endoscopy<\/h4>\n<p style=\"text-align: justify;\">Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy (eh-SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee).<\/p>\n<p style=\"text-align: justify;\">For the procedure you will swallow a thin, flexible, lighted tube called an endoscope (EN-doh-skope). Right before the procedure the physician will spray your throat with a numbing agent that may help prevent gagging. You may also receive pain medicine and a sedative to help you relax during the exam. The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach.<\/p>\n<p style=\"text-align: justify;\">The physician can see abnormalities, like inflammation or bleeding, through the endoscope that don&#8217;t show up well on x rays. The physician can also insert instruments into the scope to treat bleeding abnormalities or remove samples of tissue (biopsy) for further tests.<\/p>\n<p style=\"text-align: justify;\">Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure.<\/p>\n<p style=\"text-align: justify;\">The procedure takes 20 to 30 minutes. Because you will be sedated, you will need to rest at the endoscopy facility for 1 to 2 hours until the medication wears off.<\/p>\n<h4>Preparation<\/h4>\n<p style=\"text-align: justify;\">Your stomach and duodenum must be empty for the procedure to be thorough and safe, so you will not be able to eat or drink anything for at least 6 hours beforehand. Also, you must arrange for someone to take you home. You will not be allowed to drive because of the sedatives. Your physician may give you other special instructions.<a href=\"#footnote_5_5065\" id=\"identifier_7_5065\" class=\"footnote-link footnote-identifier-link\" title=\"http:\/\/digestive.niddk.nih.gov\/ddiseases\/pubs\/upperendoscopy\/index.htm\">5<\/a><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-family: 'Open Sans', 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; font-weight: bold; line-height: 1.4;\">What\u00a0Biopsy Specimens Show<\/span><\/p>\n<p style=\"text-align: justify;\">There are three distinct patterns of\u00a0mucosal cell\u00a0abnormalities of the small intestine:<\/p>\n<ul class=\"cp_check black\">\n<li style=\"text-align: justify;\">Infiltration of the villous epithelium with lymphocytes and a normal villi and crypt architecture. This pattern is found in 40% of individuals with dermatitis herpetiformis and a portion of first degree relatives of celiacs who have no gastrointestinal symptomatology.<\/li>\n<li style=\"text-align: justify;\">A flat mucosa characterized by villous flattening and crypt elongation with inflammatory cells in the lamina propria.\u00a0This pattern is classically found in individuals with Celiac Disease who have gastrointestinal symptoms, but has also been reported in asymptomatic celiac relatives and individuals with dermatitis herpetiformis.<\/li>\n<li style=\"text-align: justify;\">A hypoplastic mucosa characterized by villous flattening and small crypts.\u00a0This biopsy is found in the small group of patients with presumed severe celiac disease that does not improve on a gluten-free diet.<a href=\"#footnote_1_5065\" id=\"identifier_8_5065\" class=\"footnote-link footnote-identifier-link\" title=\"National Institutes&nbsp;of Health, &rdquo;National Institutes of Health Concensus Development Conference&nbsp;Statement, Celiac Disease,&rdquo; August 9, 2004;1-14.\">1<\/a><\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Celiac Disease can be associated with minimal mucosal changes on biopsy.\u00a0The\u00a0blood test may be positive and seemingly normal cells on biopsy.\u00a0However, damage to the absorptive villi may be submicroscopic, meaning changes can not yet be seen through a microscope.\u00a0This would imply a reduction of intestinal absorption is already occurring, even in this latent stage of the disease.\u00a0 In these patients, alterations of the cells may develop at a later date.<a href=\"#footnote_6_5065\" id=\"identifier_9_5065\" class=\"footnote-link footnote-identifier-link\" title=\"Sbarbati A, Valletta E, Bertini M, Cipolli M, Morroni M, Pinelli L, Tato L. &rdquo;Gluten sensitivity and&nbsp;&lsquo;normal&nbsp;histology: is the intestinal mucosa really normal?&rdquo; Digestive and Liver Disease:&nbsp;Official Journal of the&nbsp;Italian Society of Gastroenterology and the Study of the Liver. Nov 2003;35(11):768-73.\">6<\/a><\/p>\n<p style=\"text-align: justify;\">Biopsies are not fool proof. A negative report may result from poor technique in obtaining the tissue to be biopsied and\/or from inaccurate determination by the pathologist who examines it.<\/p>\n<h3>4.\u00a0Ultrasound<\/h3>\n<p style=\"text-align: justify;\">Ultrasound is especially useful for diagnosing Celiac Disease in children because it does not require needle sticks or anesthesia.\u00a0An ultrasound uses sound waves to detect an\u00a0abnormal appearance of the small bowel wall structure.<\/p>\n<h3>5.\u00a0Genetic Testing<\/h3>\n<p style=\"text-align: justify;\">More than 97% of people with Celiac Disease share the same genetic markers called HLA-DQ2 and HLA-DQ8. Checking for these markers is useful in determinig risk for Celiac Disease.<sup>2\u00a0<\/sup>The major value of HLA typing is that when it is absent it makes the diagnosis very unlikely (high negative predictive value).<a href=\"#footnote_7_5065\" id=\"identifier_10_5065\" class=\"footnote-link footnote-identifier-link\" title=\"Murray JA1, Rubio-Tapia A. Diarrhea due to small bowel diseases. Best Pract Res Clin Gastroenterol. 2012 Oct;26(5):581-600. doi: 10.1016\/j.bpg.2012.11.013.\">7<\/a><\/p>\n<p style=\"text-align: justify;\">It is useful to test blood for the HLA-DQ2 and HLA-DQ8 genetic markers in the following people:<\/p>\n<ul style=\"text-align: justify;\">\n<li>Relatives of diagnosed people with Celiac Disease.<\/li>\n<li>People with negative blood tests who exhibit manifestations of Celiac Disease.<\/li>\n<li>People with ambiguous biopsy results.<\/li>\n<li>People who started a gluten-free diet before diagnostic testing.<\/li>\n<\/ul>\n<h3><span style=\"text-align: justify;\"><br \/>\n6.\u00a0 Sugar Absorption Test<\/span><\/h3>\n<p style=\"text-align: justify;\">This is a test used to determine if there is increased permeability (\u201dleaky gut\u201d) of the\u00a0small intestine. Normal permeablity is a barrier system that does not allow harmful substances such as gliadin prolamines from gluten to pass into the bloodstream from the gut. Increased permeability is believed to contribute to the development of active Celiac Disease. The procedure simply involves drinking a dose of specific sugars and then having the urine examined later. If sugar is found in the urine, it means these sugars abnormally passed through the intestinal lining, into the blood and then were excreted in the urine.<\/p>\n<h3 style=\"text-align: justify;\">7.\u00a0 Rectal Biopsy<\/h3>\n<p style=\"text-align: justify;\">A rectal biopsy can detect an immune response to Celiac Disease. It is done in the doctor&#8217;s office by a specialist trained in the procedure.\u00a0A tiny sample of rectal tissue is removed to look under a microscope for an immune\u00a0reaction. Rectal biopsy is useful for people who did not get tested before starting a gluten free diet\u00a0and then want to definitely know if they really do have Celiac Disease.\u00a0 The test is effective within 6 months of starting a gluten free diet.<\/p>\n<h3 style=\"text-align: justify;\">Definitive Diagnosis<\/h3>\n<p style=\"text-align: justify;\">With both positive blood and biopsy results, a presumptive diagnosis of Celiac Disease can be made. Definitive diagnosis is confirmed when symptoms resolve subsequently with a gluten-free diet.<\/p>\n<p style=\"text-align: justify;\">In the case of a positive blood test and normal biopsy result, the choices include additional small bowel biopsies, periodic monitoring with blood tests, or a trial of gluten-free diet.<\/p>\n<ol class=\"footnotes\"><li id=\"footnote_1_5065\" class=\"footnote\">National Institutes\u00a0of Health, \u201dNational Institutes of Health Concensus Development Conference\u00a0Statement, Celiac Disease,\u201d August 9, 2004;1-14.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_1_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_8_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_5065\" class=\"footnote\">Murray, J. \u201dThe Widening Spectrum of Celiac Disease.\u201d\u00a0<em>American Journal of Clinical Nutrition<\/em>. Mar\u00a01999;69(3):354-365.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_2_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_3_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_4_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_5065\" class=\"footnote\">Horvath K. \u201dComments on Celiac Screening Test.\u201d Pediatric Gastroenterology and Nutrition\u00a0Laboratory, UMAB\/Bressler Research Building,\u00a0Room 10-047, 655 West Baltimore Street, Baltimore,\u00a0MD. 21201.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_5_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_5065\" class=\"footnote\">Harewood GC, Holub JL, Lieberman DA. \u201dVariation in\u00a0small bowel biopsy performance among diverse endoscopy\u00a0settings: results from a national endoscopic database.\u201d\u00a0<em>American Journal of\u00a0Gastroenterology<\/em>.\u201d Sep 2004;99(9):1790-4.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_6_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_5_5065\" class=\"footnote\"><a href=\"http:\/\/digestive.niddk.nih.gov\/ddiseases\/pubs\/upperendoscopy\/index.htm\">http:\/\/digestive.niddk.nih.gov\/ddiseases\/pubs\/upperendoscopy\/index.htm<\/a><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_7_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_6_5065\" class=\"footnote\">Sbarbati A, Valletta E, Bertini M, Cipolli M, Morroni M, Pinelli L, Tato L. \u201dGluten sensitivity and\u00a0&#8216;normal\u00a0histology: is the intestinal mucosa really normal?\u201d Digestive and Liver Disease:\u00a0<em>Official Journal of the\u00a0Italian Society of Gastroenterology and the Study of the Liver<\/em>. Nov 2003;35(11):768-73.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_9_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_7_5065\" class=\"footnote\">Murray JA1, Rubio-Tapia A. Diarrhea due to small bowel diseases. <em>Best Pract Res Clin Gastroenterol.<\/em> 2012 Oct;26(5):581-600. doi: 10.1016\/j.bpg.2012.11.013.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_10_5065\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>How Is Celiac Disease Diagnosed? Diagnosing Celiac Disease can be difficult and frustrating for both the patient and the doctor because each person is affected individually. With no definite set of symptoms to cause suspicion,\u00a0the single most important step in getting a diagnosis of\u00a0Celiac Disease is\u00a0to recognize its myriad\u00a0features.1 People who have any of the &#8230;<\/p>\n","protected":false},"author":7,"featured_media":9036,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[957,948],"tags":[1995,958,2000,959],"class_list":["post-5065","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-diagnosis-testing","category-gluten-disorders","tag-celiac-disease","tag-diagnosis","tag-gluten-sensitivity","tag-testing"],"_links":{"self":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/5065","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/comments?post=5065"}],"version-history":[{"count":13,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/5065\/revisions"}],"predecessor-version":[{"id":18671,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/5065\/revisions\/18671"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media\/9036"}],"wp:attachment":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media?parent=5065"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/categories?post=5065"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/tags?post=5065"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}