Update on Diagnostic Tests for Celiac Disease (worldwide guidelines)

Disclaimer: This information is purely for informative educational purposes. It is not for nor against biopsies for Celiac Disease. The reference links are included for your own reading. You have the right to make your own medical decisions but you can only do so if you know what the choices are.



The diagnosing of Celiac Disease is important to understand for anyone who currently has this condition and who thinks they could have.

As a Celiac, we have a responsibility to understand our own condition so that we can advocate for ourselves but also for anyone else who is new to it, especially those trying to find out if they could have it.

That person could be your parent, sibling, friend or child.



As a health coach and genetic practitioner, I cannot treat, cure or diagnose anything. However, as a health coach, I coach clients with Celiac Disease. My job is mainly to assist them with the transitioning  and to provide support both emotionally and practically as they maneuver their new lifestyle in all aspects: diet and nutrition, lifestyle, social, mental and emotional. My aim is to also help them improve their gut health as most of them have intestinal permeability from the damage caused by gluten.


As a Celiac myself I continue to do research and stay updated on the latest findings. It is important, even though I am not a doctor, that I understand how testing and diagnosing is carried out in different parts of the world as I coach internationally and can assist those clients who are not yet diagnosed in how they would go about it. I also find that it is important I understand how the different scenarios for inconclusive tests can occur so that when this does happen to a client of mine, I can support them in helping them to seek further guidance from their health care provider. My role is a guide, mentor, support for my client in all health aspects as their navigate this rocky road.


What is a biopsy?

A biopsy is a medical term for the removal of certain tissue in the body to evaluate under a microscope. A biopsy can be taken from any part of the body. In the case of Celiac Disease, it is taken from  the lining of the intestinal wall to check for villi hair damage.


What are the new Guidelines as of 2023 around the world?


United states

As of January 2023, the NEW guidelines from the ACG (American college of gastroenterolgy) in the United States for the diagnosis of celiac disease in both adults and children emphasize the importance of multiple intestinal biopsies for accurate diagnosis. However, they also acknowledge that a combination of high tissue transglutaminase IgA (Ttg-IgA) levels along with positive EMA results from a second blood sample may be used to diagnose children and symptomatic adults unwilling or unable to undergo upper gastrointestinal endoscopies.



The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Published new guidelines in 2020 regarding biopsies in children.

The full PDF can be downloaded HERE

In summary A no-biopsy approach is appropriate for children with TGA-IgA values ≥10 times the upper limit of normal with appropriate tests and positive endomysial antibodies (EMA-IgA) in a second serum sample.


South Africa

Ampath states: “In symptomatic patients with high anti-TTG IgA levels (> 10x ULN), verified by EMA positivity and who are HLA DQ2 and / or HLA DQ8 positive, histological assessment may be omitted.”



The west of Scotland pediatric Gastroenterology, Hepatology and Nutrition (WoSPGaN) new guidelines recommend that for some children who have symptoms such as diarrhea, tummy pains or poor growth, it may be possible to confirm the diagnosis of coeliac disease using the following blood tests only, without the need for a biopsy.

  • Trans glutaminase antibodies (tTG) and an endomysial antibody (EMA).

Your child will need to have two separate blood tests. The results need to be at a certain level to confirm the diagnosis.

  • Human leukocyte antigen (HLA)


Positive endomysium antibodies (EmA) and high concentrations of tissue transglutaminase antibodies (tTG) have excellent accuracy for coeliac disease. The updated guideline recommends using tTG as the first-line diagnostic investigation. Diagnosis can be made without endoscopy in subjects with tTG >10x upper limit of normal and positive EmA; in other cases intestinal biopsy is needed.



In Conclusion

Make sure that you know how testing is done, what tests are done and your rights. But also understand that medical providers differ from place to place in their approach and they are the professionals who have been trained in this regard.

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