2 out of 5 Americans have gastrointestinal disorders: up to 20% are affected by IBS, 0.44% impacted by Crohn's and Ulcerative Colitis, and up to 1% with celiac disease. 1-3
Accurate diagnosis of non-celiac gluten sensitivity (NCGS) and celiac disease is complex because both specific and nonspecific pathways of the immune system are involved.
The GHP evaluates an individual’s risk factors to celiac disease and Crohn’s disease, presence of gluten sensitivity and other GI disorders. The GHP also includes Anti-Saccharomyces cerevisiae Antibodies (ASCA) a possible indication for Crohn’s disease. 4, 5
Celiac disease risk is determined based on the presence or absence of the HLA-DQ genotypes tested.3 While both are necessary pieces of the CD puzzle, the DQ2.5 genotypes is associated with a much greater risk of CD than the DQ8 genotype. Serum antibodies (tTG and DGP) are evaluated because of their high sensitivity and specificity for active CD. Total serum IgA is measured to test for selective IgA deficiency, which if present, reduces the significance of both tTG and DGP IgA antibody levels as predictors of untreated CD and elevates the utility of IgG antibody levels for both tTG and DGP.
ASCA tests for Crohn’s disease risk. The Alcat Test is performed to screen for gluten/gliadin sensitivity and sensitivity to non-gluten containing grains. A patient may have a non-celiac genotype as well as negative serum antibodies to gluten but still show elevated gluten sensitivity via their innate immune system, reflecting non-celiac gluten sensitivity. 6, 7
HLA-DQ Typing for celiac disease –HLA -DQ2.5 and HLA-DQ8
Strong evidence shows that in order to develop celiac disease, a person must have one or both of two genotypes known as HLA-DQ2.5 and HLA-DQ8. More than 95% of patients with celiac disease have at least one of the two genetics. Most celiac patients (more than 90%) carry the DQ2 genetic.
The absence of both genotypes would render the likelihood of developing celiac disease highly unlikely.
Alcat Test for food sensitivity
The Alcat Test identifies cellular reactions to 19 items that may trigger inflammation.
Included in this panel are the following items:
Gluten Containing: Gluten, Gliadin, Barley, Malt, Spelt, Rye and Wheat
Non-Gluten Containing: Amaranth, Quinoa, Oat, Sorghum, Rice, Corn, Millet, Buckwheat, Wild Rice, Teff, Tapioca, and Candida albicans
Tissue Transglutaminase Antibody (tTG) - IgA & IgG
In active celiac disease, damaged enterocytes produce tTG, therefore antibodies against tTG (IgA and/or IgG) are indicative of an active disease process. In patients with normal total IgA levels and negative tTG antibodies, the diagnosis of active celiac disease is unlikely. However, a certain percentage of patients with celiac disease may be seronegative. If tTG IgA is negative, while celiac disease is suspected, then additional markers included in this panel become more relevant in the diagnosis of gluten-related disorders.
Deaminated Gliadin Peptide (DGP) Antibody - IgA & IgG
Deaminated gliadin can bind with tTG and become immunogenic. Therefore, detecting the presence of elevated IgA and/or IgG antibodies against DGP is an additional indicator of active celiac disease process.
Anti-Saccharomyces Cerevisiae Antibody (ASCA)
ASCA is an indicator for the presence Crohn’s disease. The presence of ASCA may also reflect increased intestinal inflammation and permeability, including that associated with active celiac disease. 8
Total Serum IgA
It is common for celiac disease patients to be IgA deficient. It is the most common immunologic deficiency (1:400-1:700 in the general population and 1:50 in celiac disease patients) and may be the single largest contributor to false negative results in biopsy confirmed celiac disease patients. Total Serum IgA is used as a measurement to qualify IgA testing for Tissue Transglutaminase (tTG) and Deaminated Gliadin Peptide (DGP) antibody levels. When IgA levels are low or deficient, it is important to check IgG levels for both tTG and DGP (included in this profile).
*Any Alcat Test panel can be added to the GHP
Cell Science Systems, Corp. is a specialty clinical laboratory that develops and performs laboratory testing in immunology and cell bioligy supporting the personalized treatment and prevention of chronic disease. Call Science Systems, Corp. operates a CLIA certified laboratory and is an FDA inspected and registered, cGMP medical device manufacturer meeting ISO EN13485 2012 standards.
Cell Science Systems fulfills high quality standards in accordance with state, federal and international regulations.
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1 Hulisz D. The Burden of Illness of Irritable Bowel Syndrome: Current Challenges and Hope for the Future. J Manag Care Pharm. 2004;10(4):299-309
2 Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology. 2004 May;126(6):1504-17.
3 Gasbarrini GB, Mangiola F. Wheat-related disorders: A broad spectrum of ‘evolving’ diseases. United European Gastroenterol J. Aug 2014; 2(4): 254–262
4 Zholudev A, Zurakowski D, Young W, Leichtner A and Bousvaros A. Serologic Testing with ANCA, ASCA, and Anti-OmpC in Children and Young Adults with Crohn's Disease and Ulcerative Colitis: Diagnostic Value and Correlation with Disease PhenotypeDiagnostic Value and Correlation with Disease Phenotype. The American Journal of Gastroenterology. 2004; 99:2235-2241.
5 Forcione DG, Rosen MJ, Kisiel JB, Sands BE. Anti-Saccharomyces cerevisiae antibody (ASCA) positivity is associated with increased risk for early surgery in Crohn's disease. Gut. 2004 Aug;53(8):1117-22.
6 Bernardo D, Garrote JA, Arranz E. Are non-celiac disease gluten-intolerant patients innate immunity responders to gluten? Am J Gastroenterol. 2011 Dec;106(12):2201-2.
7 Sapone A, Lammers KM, Casolaro V, Cammarota M, Giuliano MT, De Rosa M, Stefanile R, et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011 Mar 9;9:23
8 Damoiseaux JG, Bouten B, Linders AM, Austen J, Roozendaal C, Russel MG, Forget PP, Tervaert JW. Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies for inflammatory bowel disease: high prevalence in patients with celiac disease. J Clin Immunol. 2002 Sep;22(5):281-8.
The GHP does not provide a diagnosis of Celiac Disease or any other symptoms. It is for informational purposes only and does not constitute medical advice or treatment in any way. If the test results indicate a strong celiac disease susceptibility a thorough clinical evaluation should follow.