NutrixeYou suspect coeliac disease — in yourself, in your child, or because a doctor raised the possibility. Good news: the diagnostic path today is well mapped out, minimally invasive and reliable. It comes down to two steps: a blood test, then, if that comes back positive, an endoscopy with biopsies. But it rests on a golden rule that too many people discover too late: don’t cut gluten out of your diet before testing is complete. Here’s why, and what each step actually looks like.
The golden rule: keep eating gluten
Every test in the diagnostic process looks for traces of your body’s reaction to gluten: antibodies in the blood, damage to the intestinal lining. If you stop eating gluten beforehand, those traces fade — antibody levels drop, the gut lining heals. The result: falsely normal test results, a missed diagnosis, and the uncomfortable choice between living without an answer or reintroducing gluten for several weeks to redo the tests.
It’s counterintuitive — when you feel unwell after eating bread, the natural instinct is to cut it out. Resist that instinct until you get medical clearance: it’s the best thing you can do for your future diagnosis.
Step 1: the blood test
The starting point is a simple blood test, prescribed by a GP or paediatrician. You don’t need to fast beforehand. The lab mainly checks for:
- IgA anti-transglutaminase antibodies: the reference marker for coeliac disease, both sensitive and specific.
- Total IgA levels, measured at the same time. Why? Some people with coeliac disease have an IgA deficiency: in their case, the main test can come back falsely negative. Measuring total IgA helps catch this scenario — the doctor then relies on other antibodies (IgG class) so nothing gets missed.
Results generally come back within a few days. A negative serology with normal IgA levels makes coeliac disease very unlikely; a positive serology doesn’t confirm the diagnosis yet, but it opens the door to step two.
Step 2: endoscopy and biopsies
If the antibodies come back positive, a gastroenterologist will suggest an upper digestive endoscopy: a thin, flexible tube fitted with a camera, passed through the mouth down to the start of the small intestine (the duodenum). The procedure takes a few minutes, is usually done under sedation or light anaesthesia, and leaves no after-effects — the main inconvenience is fasting that morning.
During the procedure, the doctor takes tiny samples of the intestinal lining: the biopsies. This is painless (the gut lining has no pain receptors) and it’s the heart of the diagnosis: under the microscope, doctors look for villous atrophy — the flattening of the folds that absorb nutrients, which coeliac disease gradually wears down.
In children, European guidelines allow, in certain well-defined cases (very high antibody levels, confirmed by a second marker), a diagnosis to be made without a biopsy. It’s the paediatric gastroenterologist who makes that call, case by case.
In summary: the typical pathway
| Step | Where | What’s being checked | Key point |
|---|---|---|---|
| Consultation | GP | Symptoms, family history | Discuss it, don’t downplay it |
| Blood test | Lab | IgA anti-transglutaminase antibodies + total IgA | Keep eating gluten |
| Endoscopy + biopsies | Gastroenterologist | Villous atrophy | Still on gluten |
| Diagnosis and follow-up | Doctor | Diagnosis, assessment, support | The diet starts here, not before |
What about family?
Coeliac disease has a strong genetic component: the parents, siblings and children of someone diagnosed have a markedly higher risk than the general population — which is why family screening via blood test is recommended, even without any symptoms. Many cases are silent or atypical (fatigue, anaemia, subtle issues) and only come to light through screening. If you’ve just been diagnosed, telling your relatives is probably the single most useful thing you can do for them. Coeliac UK, the national charity for people with coeliac disease, publishes clear resources to help with this.
After the diagnosis: genuinely good news
A confirmed diagnosis is, first and foremost, an explanation — often after years of unexplained symptoms. And it comes with a treatment that’s remarkably simple by medical standards: no lifelong medication, just a strictly gluten-free diet, which lets the gut heal and symptoms subside. There’s a learning curve at the start (reading labels, cross-contamination, eating out), but thousands of fully gluten-free places exist around the world — which is exactly what the Nutrixe map tracks, address by address, verification by verification.
And if your test results conclude that it’s not coeliac disease, even though gluten does seem to bother you, other explanations exist: our article on the differences between coeliac disease, gluten sensitivity and wheat allergy covers it in detail.
This information does not replace medical advice. The pathway described here is the typical one: only a doctor can prescribe and interpret the tests suited to your situation. And one essential reminder: don't cut gluten out of your diet before you've been tested.
