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Celiac Disease in Children: Diagnosis

If you suspect your child has celiac disease, it is best to get a confirmed diagnosis. The diagnosis of celiac disease in children often starts with blood testing and is typically followed by an intestinal biopsy obtained during an upper endoscopy. This is a safe, non-surgical procedure.

 

Celiac Blood Tests

 

Contact your child’s pediatrician and request a celiac disease blood test. Bring your completed Celiac Symptoms Checklist along to help discuss your child’s signs and risks.

The pediatrician will order one or more of a series of blood tests to measure your child’s response to gluten.

Currently, recommended tests include: 

  • Total IgA
  • IgA-tTG
  • IgA-EMA
  • If IgAis low , IgG TTG or IgG-DGP may be ordered as screening tests.   At the discretion of the pediatrician, IgG-AGA can also be ordered.

*It is critically important to continue feeding your child a normal, gluten-containing diet before getting tested for celiac. Eliminating gluten before the blood test could alter the results and lead to an incorrect diagnosis.

Results

If results indicate your child has celiac:

Your child’s pediatrician may recommend that you see a pediatric gastroenterologist to confirm the diagnosis with an endoscopy.

If results indicate your child does not have celiac:

Some pediatricians may still recommend a trial gluten-free diet to see if that relieves symptoms. If symptoms subside on a gluten-free diet, it is likely that your child has non-celiac gluten sensitivity and should remain on a gluten free diet.  However, this child would not be diagnosed with celiac disease.   

If your child continues a normal gluten-containing diet, the pediatrician may recommend retesting for celiac in 1-3 years.

Testing in Children Under 3

Blood tests are not always accurate in very young children. If your child is less than 3 years old, you may be advised to see a gastroenterologist instead of relying on blood tests results.
 

Genetic Tests

Genetic testing is another way to rule out celiac disease and could be a good option for your child. The test will identify whether your child has the HLA-DQ2 or DQ8 gene.  If your child has neither of these genes, the likelihood of celiac disease is very low.

Results

If your child tests positive for the HLA-DQ2 or DQ8:

This would indicate that your child is potentially at risk for developing the condition. However, it is important to know that a high percentage of healthy people without celiac disease also have one or both of these genes. Speak with your child’s pediatrician to determine your next course of action.

If your child tests negative for the HLA-DQ2 AND DQ8:

This would indicate that your child is very unlikely to develop celiac disease.
 

Endoscopy and Biopsy

Intestinal biopsy is considered the ‘gold standard’ for celiac diagnosis and can give you a definitive answer to your child’s health problems.

The biopsy is taken during an upper gastrointestinal endoscopy, which is a very safe and routine procedure. Some preparations are needed, and your child may be lightly sedated during the procedure. However, the actual endoscopy only takes about 15 minutes.

During the endoscopy, a pediatric gastroenterologist will use a small flexible camera scope to examine your child’s intestinal wall/lining. They will be looking for damage or flattening of the villi (small fingerlike projections). A few biopsies will be taken for microscopic review to confirm your child’s diagnosis.

*Medical content reviewed by Karen Francolla, MD, Center for Pediatric G.I. and Nutrition, Hackensack University Medical Center.

 

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