Coeliac antibody screening, with the crucial detail people get wrong: you must still be eating gluten.
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Coeliac disease is an autoimmune reaction to gluten that damages the lining of the small intestine. It affects roughly 1 in 100 people in the UK, and the majority are undiagnosed — average time to diagnosis is more than a decade, and many spend years labelled with IBS first.
It is not an allergy and not an intolerance. That distinction matters, because it changes both how it is tested for and how strictly it must be managed.
Tissue transglutaminase IgA antibodies (tTG-IgA) — the standard first-line test. In someone eating gluten it is highly sensitive.
Total IgA — measured alongside, and this is the part most often skipped. Around 1 person in 500 is IgA deficient, and in those people the tTG-IgA test reads negative whether or not they have coeliac disease. Without checking total IgA, a negative result in that group is meaningless, and an alternative IgG-based test is needed instead.
What the blood test cannot do is confirm the diagnosis. In adults, a positive antibody result needs endoscopy with duodenal biopsy to confirm — and you must still be eating gluten when that happens, which is why the order of events matters so much.
Included: tissue transglutaminase IgA antibodies, with total IgA measured alongside.
The total IgA matters: around one person in 500 is IgA deficient, and in those people the standard coeliac test reads negative regardless of whether they have the condition. Without checking it, a negative result cannot be trusted.
1. Consultation — and the timing question comes first. You must be eating gluten in more than one meal a day for at least six weeks before the test. If you have already cut it out, the test will very likely come back negative regardless of the truth — which is exactly what happens to people who removed gluten because it seemed to help. That is the single commonest reason coeliac disease is missed, and we would rather delay testing than produce a falsely reassuring result.
2. Referral. To a Randox Health clinic. We usually request ferritin, B12 and folate and full blood count alongside, since deficiencies are the norm rather than the exception.
3. The sample. A single blood draw, no fasting.
4. Results review. A positive result means gastroenterology referral for confirmatory biopsy — still eating gluten until it is done. A confirmed diagnosis means a strict lifelong gluten-free diet, dietitian input, bone density assessment and ongoing monitoring, and we set all of that out rather than leaving you with a result.
You must be eating gluten in more than one meal a day for at least six weeks before the test. No fasting required.
You must be eating gluten for the test to work. More than one meal a day containing gluten, for at least six weeks beforehand.
If you have already cut it out, the test will read negative regardless of whether you have coeliac disease — the antibodies fall once the trigger is removed. People lose the diagnosis this way constantly, and getting it back means eating gluten again for six weeks, which nobody wants to do twice.
Around one person in 500 is IgA deficient, and in those people the standard coeliac antibody reads negative whether or not they have the condition.
Without checking total IgA, a negative result cannot be trusted. It is a cheap addition and it is frequently omitted.
Coeliac disease is confirmed by biopsy in adults — a gastroscopy taking samples from the small bowel. A raised antibody makes it likely; the biopsy establishes it.
And critically: keep eating gluten until the biopsy is done. Stopping between the blood test and the endoscopy can normalise the bowel lining and cost you the diagnosis at the final step.
Untreated coeliac disease causes osteoporosis, iron and B12 deficiency, infertility and a small increase in certain cancers — in people who may have few gut symptoms at all.
A formal diagnosis also brings prescribable gluten-free food in some areas, annual follow-up, bone density monitoring, and screening for first-degree relatives, who carry roughly a 1 in 10 risk. Self-diagnosing by cutting out gluten gets you none of that.
A small proportion of people with coeliac disease have a negative antibody test even while eating gluten — particularly children under two and people with IgA deficiency.
Where the clinical suspicion is strong, a negative result should not close the question.
It is not a food intolerance test, and it does not screen for gluten sensitivity in general. IgG food intolerance panels have no scientific validity and we do not offer them — a point worth making here specifically, because they are marketed hardest at exactly the people asking this question.
Coeliac screening is free on the NHS with relevant symptoms, and the confirmatory gastroscopy is an NHS procedure.
This is one test where the NHS pathway is genuinely the better route end to end, because a private antibody result still needs an NHS endoscopy to confirm — and the follow-up, bone monitoring, dietitian access and family screening all sit there.
Where we are useful is speed, and making sure the test is done correctly — on gluten, with total IgA included.
Cutting out gluten before testing costs you the diagnosis, and with it the annual follow-up, bone density monitoring, prescribable food where available, and screening for your children and siblings.
It is the most expensive free mistake on this page.
Not reliably — and this is the most important thing on the page.
The test will read negative whether or not you have coeliac disease, because the antibodies fall once gluten is removed.
To test properly you would need to eat gluten in more than one meal a day for at least six weeks. That is unpleasant if it makes you unwell, which is exactly why testing first matters.
Because coeliac disease is not simply a food intolerance, and the label changes what happens next.
A formal diagnosis brings annual follow-up, bone density monitoring, dietitian access, prescribable gluten-free food in some areas, and screening for first-degree relatives — who carry roughly a 1 in 10 risk.
Self-diagnosing gets you none of that, and untreated coeliac disease causes osteoporosis, deficiencies and fertility problems even in people with few gut symptoms.
Around one person in 500 is IgA deficient, and in those people the standard coeliac test reads negative regardless.
Without measuring total IgA, a negative result cannot be trusted — and it is frequently left out.
In adults, yes — biopsy remains the confirmatory test. A raised antibody makes coeliac disease likely; the biopsy establishes it.
And keep eating gluten until the biopsy is done. Stopping in between can normalise the bowel lining and cost you the diagnosis at the last step.
That is a recognised situation. Non-coeliac gluten sensitivity is real, though there is no blood test for it — it is diagnosed by exclusion.
It may also not be the gluten. Fructans in wheat cause identical symptoms in many people with IBS, which is why a low-FODMAP approach sometimes works where gluten-free alone does not.
First-degree relatives carry roughly a 1 in 10 risk, so testing is recommended — particularly with symptoms, poor growth or unexplained anaemia.
They need to be eating gluten for the test to mean anything.
Yes — it is frequently diagnosed in adults, including in people in their sixties and seventies. It is not a childhood condition that you either have or do not.
It also presents without obvious gut symptoms surprisingly often — as unexplained iron deficiency, fatigue, osteoporosis, mouth ulcers or infertility.
Not reliably. Most do not measure total IgA, which means a negative cannot be interpreted — and none replaces the biopsy.
A positive home test still needs proper assessment, and a negative one may be false.
Yes — coeliac disease travels with other autoimmune conditions, particularly thyroid disease and type 1 diabetes, and it causes iron, B12, folate and vitamin D deficiency.
Which is why we generally request those alongside rather than one at a time.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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