The Celiac Serologic Panel: Getting It Right the First Time
The Celiac Serologic Panel: Getting It Right the First Time Two tests, one massive pitfall, and the number-one mistake that makes the whole workup useless. Celiac disease affects roughly 1 in 100 people, but up to 80% of cases remain undiagnosed. It masquerades as IBS, iron deficiency anemia, unexplained osteoporosis, chronic fatigue, infertility, and even "normal" GI symptoms that patients have lived with for years. The serologic panel is straightforward—but there are pitfalls that will make you miss the diagnosis entirely if you don't know them. Let's get this one right. The Tests: What to Order and Why The First-Line Screen: tTG-IgA + Total IgA That's it. For most patients over age 2, you need exactly two tests : 1 tTG-IgA (Tissue Transglutaminase IgA Antibody) The preferred screening test per ACG, AGA, and ESPGHAN guidelines. Sensitivity of 93–98%, specificity of 96–98%. This is the workhorse of celiac diagnosis. If it's positive, you're on the righ...