Order Guide: Celiac Disease Screening

Celiac Disease is an autoimmune disease where the body’s small intestine becomes inflamed in response to gluten exposure. Gluten is the term for various proteins found in grains including barley, wheat, rye, spelt and kamut. Approximately 0.5-1% of the global population has celiac disease, with a large majority of those individuals unaware of their condition. Celiac disease is a separate condition from gluten insensitivity. An individual can experience gluten allergy symptoms (abdominal cramping, diarrhea, bloating) with gluten ingestion, without having inflammation within their small intestine that is classically reported in celiac disease. Symptoms of celiac disease, and gluten allergy overlap with symptoms of irritable bowel syndrome.
  • Constipation, diarrhea, weight loss, abdominal pain
  • Osteoporosis
  • Eczema like skin changes (dermatitis herpetiformis)
  • Diarrhea
  • Weight loss
  • Malabsorption (deficiencies of B1/B2/B3/B6/B12)
  • Neurological symptoms: neuropathy, epilepsy, depression, anxiety, fatigue
  • Burning sensation or soreness of the tongue
  • Iron deficiency anemia
  • No symptoms

It is important to understand that to get an accurate screening test for celiac disease, you must be on a diet containing gluten.
  • Regular gluten challenge: eat 4-6 slices of bread (8-10 grams of gluten) for 6-8 weeks before the blood test is completed
  • Modified gluten challenge: (for individuals unable to tolerate a full gluten challenge) - a smaller quantity of gluten consisting of 1.5 slides of bread (3 grams) can be consumed for 4 weeks and a test is completed at the end of 4 weeks. if the screen is negative, continue the modified challenge for 8 more weeks (12 weeks in total) before repeating the test.
  • Celiac testing looks for anti-TTG IGA antibodies and total IgA levels.

  • You should be evaluated by a gastroenterologist to consider a biopsy of the small intestine, done through a relatively straightforward procedure called an endoscopy. If you have a positive or indeterminate screen, a TeleTest physician will reach out to you to discuss your results and next steps.

Gliadin is a component of gluten. Some antibody tests check for antibodies to gliadin.

Celiac testing is covered for individuals suspected of having a diagnosis of celiac disease, who have never been diagnosed in the past with celiac disease. The province of Ontario is running a pilot program where celiac testing is covered until March 31, 2023.

Private labs offer uninsured testing which also includes Anti-Deamidated Gliadin IgG (DGP-IgG) in addition to the standard anti-TTG IGA test. This is not required to make a diagnosis of celiac disease.
References:
[1] https://pubmed.ncbi.nlm.nih.gov/22619366/
[2] https://www.celiac.ca/healthcare-professionals/diagnosis/gluten-challenge/
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What is celiac disease?
What are common symptoms related to celiac disease?
How do I test for celiac disease?
What happens if I test positive for celiac disease?
What is Gliadin?
Is celiac testing covered under OHIP?
Is the screening offered by TeleTest different than the screening panels offered by Life Labs and Dynacare?