Developing a new blood test for coeliac disease

Current blood tests for coeliac disease work well in discriminating people who have coeliac disease from those who don’t but this is only true if they are on a normal diet containing gluten – the substance in foods that triggers the disorder. 

Many people who present to their doctors worried that they may have coeliac disease have already put themselves on a gluten-free diet. After a few weeks on a gluten-free diet the usual blood tests gradually stop working. Current guidelines recommend performing a gluten challenge involving daily consumption of gluten for up to 8 weeks, followed by an endoscopic procedure for a biopsy taken from the duodenum (the first part of the small intestine). If the person does have coeliac disease, following a diet containing gluten for 8 weeks may lead to them having distressing symptoms during that time. 

Norwegian researchers have developed a new type of blood test that shows promise in determining whether or not a person has coeliac disease even if they are on a gluten-free diet. Current blood tests for coeliac disease rely on detecting specific antibodies to components of gluten but these gradually disappear in people who avoid gluten.

The new test detects immune cells in a patient’s blood that are specifically targeted at gluten proteins, even when the individual hasn’t been recently exposed to gluten. A substance that binds to gluten-sensitized immune cells was added to the patient’s blood sample and then the cells counted using a technique called flow cytometry. 

The researchers tried out their test in a relatively small sample of 62 patients with coeliac disease and 19 individuals without coeliac disease who were on a gluten-free diet, 10 patients with coeliac disease who were eating foods containing gluten and 52 healthy individuals following normal diets. The new cell-based test had good sensitivity – it was able to detect 60 out of 62 people with known coeliac disease who were following a gluten-free diet while conventional antibody-based tests only detected 4 out of 62. The specificity of the test was a little lower – it had a small false-positive result rate. 

If these results are confirmed in larger studies then this new test will be a valuable addition to patients, gastroenterologists and pathology laboratories in assisting with the diagnosis of coeliac disease.

Further reading
Gastroenterolgy jounal abstract  
Rueters - Accurate celiac diagnosis in trial of new blood test  

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