Expert Rev Gastroenterol Hepatol. 2025 Feb 4:110.doi:10.1080/17474124.2025.2462245. Online ahead of print.

Marleena Repo ^1 2 3, Sara Koskimaa ^2 3, Saana Paavola ^2 4, Kalle Kurppa ^1 2 3 5

Author information

¹Department of Pediatrics, Tampere University Hospital and Wellbeing Services County of Pirkanmaa, Tampere, Finland.

²Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

³Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland.

⁴Department of Internal Medicine, Tampere University Hospital and Wellbeing Services County of Pirkanmaa, Tampere, Finland.

⁵The University Consortium of Seinäjoki, Seinäjoki, Finland.

Abstract

Introduction: Celiac disease is one of the most common chronic immune-mediated gastrointestinal conditions, characterized by the presence of disease-specific serum antibodies against self-antigen transglutaminase 2. Even though modern serological assays can identify most untreated celiac disease patients and are also increasingly being used to establish a diagnosis, several challenges are associated with the tests, including a lack of standardization, the variable sensitivity and specificity of commercial assays, and inadequate sensitivity for monitoring adherence to a gluten-free diet.

Areas covered: This narrative review outlines the current use of serological tests in case-finding and screening, as well as in the follow-up of dietary treatment. Additionally, the possible challenges and pitfalls of serological tests, along with future directions, are addressed.

Expert opinion: The excellent accuracy of modern autoantibody tests, especially for greatly elevated levels of transglutaminase 2 antibodies and positive endomysial antibodies, enables using serological testing in establishing a diagnosis. However, better international standardization of the assays is required, the necessity of endomysial antibody testing needs to be further scrutinized, and additional research is needed to improve noninvasive tools for follow-up and to further expand the no-biopsy criteria for celiac disease.