Diagnosing Coeliac

16 May 2023

May is Coeliac Awareness Month.

Did you know SA Pathology has a major role in diagnosing coeliac disease?

Diagnosis can help people get answers and prevent future health complications.

What is coeliac disease?

Coeliac disease is an autoimmune condition where the immune system responds in an abnormal way to gluten, which leads to damage to the small bowel wall.

The inside of the small bowel is covered in finger-like projections called ‘villi’ which are very important for absorbing nutrients. Inflammation caused by coeliac disease flattens the villi so they are unable to absorb nutrients normally (see picture below). This leads to symptoms such as diarrhoea, abdominal pain and weight loss and deficiencies in vitamins and nutrients including iron, folate and vitamin B12.

Illustration showing a healthy small bowel with normal villi, and coeliac disease with flattened villi.

Does everyone with a sensitivity to wheat have coeliac disease?

It would make sense, especially with the number of people adapting to a strictly gluten free diet, but not all symptoms associated with eating wheat (or gluten) are due to coeliac disease. Some individuals are intolerant to wheat and can have difficulty digesting the carbohydrate component, which can lead to problems such as abdominal pain or bloating.

Others may develop allergic reactions immediately after eating wheat, with symptoms including rash, hives or a more severe reaction (anaphylaxis).

Anyone with concerns about signs and symptoms associated with eating wheat or gluten should consult their doctor for advice.

How do we help to diagnose coeliac disease?

SA Pathology delivers three types of testing for people who may have coeliac disease.

Coeliac antibody testing

Dr Jovanka King, Consultant Immunopathologist, says,"Our laboratory provides a test performed on a blood sample, which looks for two key antibodies that are typically found to be present at high levels in individuals who have coeliac disease. This test is usually the first step in diagnosing coeliac disease. If an individual has a positive antibody test which suggests coeliac disease, their doctor will usually refer them to a gastroenterology specialist for further advice."

Genetic testing

Genetic testing on a blood sample can be used to determine the likelihood that an individual will develop coeliac disease.

Dr King says, "A large proportion of the general population carry changes in key genes which indicate they may have a chance of developing coeliac disease. If an individual is found not to carry any of these gene changes, it is highly unlikely that they will develop coeliac disease. In some situations, this test can be helpful in excluding coeliac disease, and doctors can then consider other causes for a person’s symptoms."


In some cases, gastroenterology specialists may arrange a procedure called an endoscopy, where a biopsy of the small bowel is taken, and a small piece of the bowel tissue is looked at under the microscope. This test is performed by our SA Pathology Anatomical Pathology team. They will identify any changes in the bowel (such as flat villi) and help make the diagnosis of coeliac disease.

What happens if coeliac disease is untreated?

Coeliac disease is treated with a very strict gluten-free diet. As well as the symptoms and nutritional deficiencies that can occur, people with coeliac disease can sometimes develop a rash, and are also potentially at risk of developing cancerous changes in the bowel.

Dr King says awareness and early diagnosis is important."Coeliac disease can present with many different signs and symptoms and is an important condition to think about for individuals who have problems such as abdominal pain or diarrhoea, unexplained iron or other nutritional deficiencies, and also in children who are not growing well. Because coeliac disease can run in families, testing may be recommended for other family members.

While awareness of coeliac disease is increasing, it is not uncommon for some people to have symptoms for months or years before they seek medical review or are diagnosed with this condition."

Learn more about the symptoms of coeliac disease by visiting www.coeliac.org.au

Time for your next blood test? Find a collection centre closest to you.

To book a specialised test call us on 8222 3000.

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