To screen for celiac disease in a patient with iron deficiency anemia, which test is preferred?

To screen for celiac disease in a patient with iron deficiency anemia, which test is preferred?

• A. Antigliadin
• B. All of the above
• C. Anti-tTG
• D. Antigluten

Answer: (C)

Screening for celiac disease should use a serologic test with the best balance of accuracy. The antibody against tissue transglutaminase (anti-tTG) fits that need because it has high sensitivity and specificity for celiac disease, making it the most reliable first-line screen in someone with iron deficiency anemia. Anti-gliadin antibodies used to be common but are much less specific and can be influenced by age, gluten exposure, and other conditions. Anti-endomysial antibodies are very specific but testing is more labor-intensive and not as practical for routine screening. Antigluten antibodies don’t specifically reflect the disease process of celiac disease, so they’re not used as the primary test. If there’s concern for IgA deficiency, total IgA should be checked and alternative IgG-based tests can be used.

Screening for celiac disease should use a serologic test with the best balance of accuracy. The antibody against tissue transglutaminase (anti-tTG) fits that need because it has high sensitivity and specificity for celiac disease, making it the most reliable first-line screen in someone with iron deficiency anemia. Anti-gliadin antibodies used to be common but are much less specific and can be influenced by age, gluten exposure, and other conditions. Anti-endomysial antibodies are very specific but testing is more labor-intensive and not as practical for routine screening. Antigluten antibodies don’t specifically reflect the disease process of celiac disease, so they’re not used as the primary test. If there’s concern for IgA deficiency, total IgA should be checked and alternative IgG-based tests can be used.