I am confused about the gold standard in celiac disease for these reasons:
1. CLINICAL SINGS AND SYMPTOMS are not pathognomonic for CD and these are only present in symptomatic CD.
2. The enteropathy is not present in all celiac disease presentation forms (not in latent celiac disease) and when patients are on a GFD. Furthermore, a BIOPSY finding of lymphocytic duodenosis and villous atrophy are not specific for CD.
3. The antibodies could be negative if the patients are on a GFD, some patients are classify as CD without seropositive to EMA, tTG or DGP or there are patients with IgA deficiency in which the IgA EMA, tTG or DGP are negatives. For IgA deficiency patients it is usually to determine IgG to EMA, tTG or DGP.
4. The HLA DQ2 and/or DQ8 are not only present in CD, about 30% of the population are positive to these haplotype. It just has a high negative predictive value, as a negative test in this circumstance would indicate that patients are highly unlikely to have CD. Actually, HLA TYPING could be used to rule out CD. HLA typing is the only marker in which the patient does not need to be on a gluten containing diet.
5. Not only patients with CD respond to GLUTEN CHALLENGE.
Which other diagnostic test for CD do you know?
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