If antibody tests and/or symptoms suggest celiac disease, a physician should establish the diagnosis by obtaining tiny pieces of tissue from the small intestine to check for damage to the villi. This is done via endoscopic biopsy. Under sedation, the physician eases a long, thin tube called an endoscope through the mouth and stomach into the small intestine. Then, he takes tissue samples using instruments passed through the endoscope.
New guidelines released in 2012 for children allow for diagnosis without a biopsy, but only in specific cases. In these cases the genes predisposing to celiac must be present, tTG has to be very elevated and EMA blood test must be clearly positive. Also, there must be a positive response to a gluten-free diet.
Of note, guidelines for diagnosis in adults continue to call for the biopsy in all cases, with no exceptions. Read our Factsheet, “Diagnosing Celiac Disease
,” to learn more. May, 2017