Diagnosis

What tests are needed?

When gluten comes into contact with the intestinal lining of a person who is sensitive to it, changes occur which are detectable under a microscope. The characteristic change is flattening of the projections called ‘villi’, which resemble pile in a carpet, though in a few people there may only be an alteration in the surface layer of cells.

The most important test is to examine a tiny snip, known as a biopsy, from the surface of the small intestine.
A flexible telescope (endoscope) is usually passed through the mouth into the stomach and upper intestine so that the lining can be inspected and a biopsy taken.

This process takes only a few minutes and is often made easier and less uncomfortable by giving a mild sedative beforehand. Alternatively, a biopsy can be obtained by swallowing a special capsule on the end of a narrow tube.

If the biopsy is abnormal, a second test may be advised after a period to check that the intestinal surface returns towards normal.


When there is doubt about a previous diagnosis, or the changes on biopsy are uncertain, another biopsy may be advised after a person deliberately takes gluten for a period (gluten challenge).

Blood tests are helpful in detecting the body’s reaction (antibodies) to gluten or as an indication of intestinal damage. Other blood tests indicate deficiencies of iron, vitamins such as folic acid, or minerals such as calcium. Inherited susceptibility can also be suggested by a blood test. Such blood tests are useful for screening relatives or to suggest that gluten sensitivity may be the cause of symptoms or nutrient deficiency. These tests do not make the diagnosis but indicate the advisability of a biopsy test.

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