Monday, December 04, 2006

What tests should I ask the doctor for?

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A doctor may order one or more celiac disease tests, along with tests to evaluate the status and extent of a patient’s malnutrition and malabsorption. There are four autoantibodies that are related to celiac disease that can be measured. The doctor will often order an Anti-tissue Transglutaminase Antibody (tTG), IgA first to screen for celiac disease. If this test is positive, it is likely that the patient has celiac disease. The doctor may perform an intestinal biopsy to confirm that there is damage to the intestine. If the Anti-tTG is negative but the physician still suspects celiac disease, he may order other tests that include:
Anti-Gliadin Antibodies (AGA), IgG and IgA. These tests are often useful when testing young symptomatic children but they are found in fewer cases of celiac disease than Anti-tTG and they can also be positive in other diseases. AGA IgG and IgA are often ordered together so that their results can be compared. If one is positive, both should be – unless the patient has an IgA deficiency. They can be used to monitor dietary compliance.
Anti-Endomysial Antibodies (EMA), IgA. This test is being replaced by the Anti-tTG test as they both measure the autoantibodies causing the tissue damage associated with celiac disease. Anti-EMA is, however, still being ordered at this time by many physicians and may be used to monitor dietary compliance.
Anti-Reticulin Antibodies (ARA), IgA. Anti-ARA is not ordered as frequently as it once was as it is not as specific or sensitive as the other autoantibodies. It is found in about 60% of celiac disease patients and about 25% of patients with dermatitis herpetiformis.
tTG can also be used for monitoring dietary compliance.
These autoantibody tests are often ordered along with other tests to help determine the severity of the disease and the extent of a patient’s malnutrition, malabsorption, and organ involvement.

Other tests might include a:
CBC (complete blood count) to look for anemia
ESR (erythrocyte sedimentation rate) to evaluate inflammation
CRP (C-Reactive protein) to evaluate inflammation
CMP (complete metabolic panel) to determine electrolyte, protein, and calcium levels, and to verify the status of the kidney and liver
Vitamin D, E, and B12 to measure vitamin deficiencies
Stool fat, to help evaluate malabsorption

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