Scientific Barriers in the Diagnosis of Celiac Disease
A genetic predisposition in some people causes celiac disease, an autoimmune illness that affects the small intestine. A gluten-rich diet generally leads to its activation. And while many may be suffering from its symptoms, a total lack of awareness about the illness and the cumbersome scientific interventions keep most people away from the correct diagnosis.
Methods of Diagnoses
- A serological blood test is the primary investigation of the disease. One needs to confirm the presence of the TTIgA and IgA antibodies and ensure that the individual is on a gluten inclusive diet in order to have the correct results of the test.
- An endoscopy is the next level of investigation. It allows the doctors to conduct a biopsy of the small intestine in order to ascertain if there is any damage triggered by the ingestion of gluten.
- The HLA gene test is the preferred test if you know of a family member (close or distant) already diagnosed with the disease or if there is an ambiguity or discrepancy between the antibody testing and endoscopy test.
Barriers to Diagnosis
There are, however, various scientific or medical barriers to the correct diagnosis of the disease
1. False Antibody Test Results
The serological test for the TTIgA and the IgA runs the risk of generating false antibody test results. Especially if the person is already detected with another autoimmune disorder such as Type 1 Diabetes, rheumatoid arthritis, autoimmune liver disease, etc. there is a chance of having false-positive test results.
This means that one has to have other antibody tests done just to double-check, thus making a biopsy the surest way to diagnose celiac disease.
2. The Requirement of a Combination Test
Serology tests are mostly indicative and hence, doctors may prescribe a combination of tests to rule out the possibility of inaccurate results. For instance, in the case of pre-existing disease in the family, the HLA testing could accompany the antibody test. And the deamidated gliadin peptide (DGP) plus tissue transglutaminase antibodies need to both be tested for a more reliable assessment of the disease. While the HLA test can be done by a blood test, saliva test or a fecal test, it indicates the risk of developing the disease. But an endoscopy could be used to confirm the disease. The process of diagnosis, therefore, is largely indicative and cumbersome.
3. Case-Based Screening
Most people who have Celiac Disease aren’t aware they have it. Since the symptoms could be anything from joint pains and fatigue to depression and infertility or recurrent miscarriages, most people would resort to treating the symptoms for what they are without being able to identify the pattern or combination factors of their occurrence.
Unless a person is actively aware of the disease, knows of a family member who has it and is being treated by a doctor who is able to make the connection, it can go totally undetected.
The best way to deal with it is by having a mass screening of the disease as opposed to a case-based screening. Since children can also be at risk, including a test as part of their ongoing medical screening can go a long way in determining sensitivity to the disease.
4. Complicated and Costly Testing
Some of the tests themselves are not only complex but also a financial burden. The EMA test for example, maybe specific to 100% but is not as sensitive as the tTG-IgA test. It may also require a primate esophagus or human umbilical cord. Factors such as these discourage people from going out to test.
Due to the lack of awareness about the disease and the lack of accurate, viable detection methods, staying informed is the only way to help diagnose the illness. Adopting a lifestyle that is not gluten dependent and being aware of the symptoms can go a long way in keeping you healthy.