Q: How useful is a stool test (Enterolab) for the diagnosis of celiac disease and gluten intolerance?
A: As of yet, few data have been published to support the widespread use of stool testing for celiac disease and gluten intolerance. Early data do suggest that fecal levels of anti-gliadin antibodies may be elevated in patients with untreated celiac disease (
Clin Chem. 1993;39:696-697). However, preliminary studies using two commercially available stool tests for immunoglobulin A antibody against tissue transglutaminase and gliadin in children with celiac disease yielded low sensitivity. Neither test was deemed “suitable” for screening in this population (
BMJ. 2006;332:213-214). Serologic testing for tissue transglutaminase autoantibody, for example, yields much higher sensitivity and specificity, approaching 94% and 95%, respectively (
Gastroenterology. 1998;115:1322-1328). Alternate and less invasive methods are being aggressively explored and do hold promise, but for now, the mainstay of diagnosis remains the demonstration of typical villous atrophy on multiple biopsies of the small intestine in the correct clinical context.