Update on serologic testing in celiac disease

Abstract

Contemporary serologic testing has revolutionized the field of celiac disease (CD). Highly accurate serologic assays have shown the prevalence of CD to be nearly 1:100 in many populations. These mostly ELISA (enzyme-linked immunosorbent assay)-based tests allow noninvasive screening and detection. However, the growing number of available serologic tests necessitates reevaluation of their predictive power as a single test or in combination. We review the available tests for CD, including antibodies against gliadin, endomysium, tissue transglutaminase, and deamidated gliadin, and the evidence for preferential use of specific tests in different settings. Despite several novel developments, standardized ELISA-based assays for IgA autoantibodies against tissue transglutaminase remain the test of choice for most populations. We discuss the need to develop tests for CD activity in order to assess the efficacy of upcoming nondietary therapies.