Run the List Celiac Disease: Approach to Diagnosis
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Mar 30, 2026 Dr. Sith Sekar, a general gastroenterologist at Brigham and Women’s Hospital and medical educator, joins to review celiac diagnosis. They discuss when to suspect celiac in anemia and GI symptoms. Practical testing tips are covered: optimal serology, handling IgA deficiency, HLA genetic testing, and biopsy technique while patients remain on gluten.
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Celiac Is A Key Cause Of Refractory Iron Deficiency
- Always consider celiac disease in iron deficiency anemia workups.
- Three to five percent of patients with iron deficiency anemia have celiac, and malabsorption from duodenal disease explains refractory anemia.
Always Order TTG-IgA With Total IgA
- Send tissue transglutaminase IgA (TTG-IgA) and total serum IgA together.
- Checking total IgA identifies IgA deficiency that would make TTG-IgA falsely negative and informs using IgG-based tests instead.
Switch To IgG Testing In IgA Deficiency
- If total IgA is low, use IgG-based celiac tests.
- Options include TTG-IgG or deamidated gliadin peptide (DGP) IgG to detect celiac in IgA-deficient patients.