You can get tested for celiac disease starting with a simple blood test ordered by your primary care doctor, or you can go directly to a gastroenterologist. The blood draw itself happens at your doctor’s office or a national lab chain like Quest Diagnostics or Labcorp. If the blood test comes back positive, you’ll typically be referred to a gastroenterologist for a confirmatory biopsy. Here’s what to expect at each step and how to avoid the most common mistake people make before testing.
Start With Your Primary Care Doctor
Most people don’t need a specialist to begin the process. Your primary care doctor can order a celiac blood panel and have you get the draw done at any commercial lab. The key test is called tTG-IgA, which looks for specific antibodies your immune system produces when it reacts to gluten. It’s the preferred initial screening test and catches roughly 90% to 95% of celiac cases.
If that first result is borderline or your doctor wants more certainty, they may add a second antibody test called EMA-IgA. Some people have a condition called IgA deficiency, which can make these tests falsely negative. If celiac is still suspected despite a negative result, your doctor can check your total IgA level and order alternative antibody tests that aren’t affected by the deficiency.
Many labs offer a comprehensive celiac panel that bundles several of these antibody markers into a single blood draw, so you don’t need to go back multiple times.
Where to Get Blood Drawn
Once your doctor writes the order, you can get blood drawn at most places that handle routine lab work. Quest Diagnostics and Labcorp both run celiac panels and have thousands of locations across the U.S. Quest also offers in-home blood collection through its mobile service in some areas. Many hospitals and urgent care centers have on-site labs that can process the draw as well.
If you don’t have a doctor’s order, some direct-to-consumer lab services let you purchase a celiac panel online, walk into a partner lab, and get results sent to you directly. This can be useful if you’re uninsured or want results quickly, though you’ll still need a doctor to interpret them and order follow-up testing if needed.
At-Home Test Kits: Worth It?
Over-the-counter celiac screening kits are available online and at some pharmacies. These use a finger-prick blood sample to detect tTG antibodies, similar to what a lab tests for. The appeal is obvious: no appointment, no lab visit, results in minutes.
The tradeoff is accuracy. When trained nurses used rapid finger-prick testing on a general population of school-aged children in a large European study, sensitivity dropped to about 78%, meaning roughly one in five people with celiac disease got a false negative. There’s also very little data on how well these kits perform when used by people at home without clinical training. A negative result from a home kit does not rule out celiac disease. If you have symptoms, a lab-based blood test is far more reliable.
The Biopsy: Why It’s Still Needed
A positive blood test alone doesn’t confirm celiac disease in most adults. U.S. guidelines from the American College of Gastroenterology recommend an intestinal biopsy for confirmation. This means a gastroenterologist performs an upper endoscopy, threading a thin, flexible tube through your mouth and into your small intestine to collect tiny tissue samples.
The procedure is done under sedation and typically takes 15 to 20 minutes. The doctor collects four to six small samples from the lower part of the duodenum (the first stretch of your small intestine) plus two more from the duodenal bulb, because damage sometimes only appears in that area. A pathologist then examines the tissue under a microscope, looking for flattened villi (the tiny finger-like projections that absorb nutrients) and signs of inflammation.
The biopsy also gives your doctor a baseline. If you start a gluten-free diet and your symptoms don’t improve, a follow-up biopsy can help figure out why.
Children May Skip the Biopsy
European guidelines now allow a biopsy-free diagnosis for children whose tTG-IgA levels are at least 10 times the upper limit of normal, confirmed by a positive EMA-IgA test on a second blood sample. The American College of Gastroenterology has also acknowledged this no-biopsy approach for select pediatric cases. Children with positive but lower antibody levels still need a biopsy. If your child is being evaluated, a pediatric gastroenterologist can walk you through which path applies.
Don’t Stop Eating Gluten Before Testing
This is the single most important thing to know before you get tested. Celiac blood tests and biopsies detect your body’s active immune response to gluten. If you’ve already cut gluten from your diet, antibody levels drop and intestinal damage starts healing, which can produce a false negative on both the blood test and the biopsy.
If you’re still eating gluten regularly, you can test anytime. If you’ve already gone gluten-free, you’ll need to do what’s called a gluten challenge: eat gluten every day before testing so your immune system has something to react to. Recommendations vary slightly. The North American Society for Pediatric Gastroenterology recommends about two slices of wheat-based bread daily for six to eight weeks before testing. The University of Chicago’s Celiac Disease Center suggests at least one slice of bread per day for a minimum of two to three weeks before a biopsy. Either way, the message is clear: test first, then change your diet.
Genetic Testing as a Rule-Out
Celiac disease requires specific genetic markers called HLA-DQ2 or HLA-DQ8. If you don’t carry either gene, you essentially cannot develop celiac disease, which makes genetic testing a powerful way to rule it out. This is especially useful for family members of someone already diagnosed, since celiac has a strong hereditary component.
The catch is that about 20% of the general population carries these genes without ever developing celiac disease. A positive genetic test only confirms you have the potential for it, not that you have it. Labs like Mayo Clinic Laboratories offer this test, and it can be ordered through your doctor. Unlike antibody testing, genetic results aren’t affected by your diet, so you can do this test whether or not you’re eating gluten.
What Testing Typically Costs
With insurance, a celiac blood panel is often covered as diagnostic lab work when ordered by a physician for symptoms or family history. Your out-of-pocket cost depends on your plan’s lab benefits and deductible. Without insurance, a celiac antibody panel through a commercial lab generally runs between $100 and $300. An upper endoscopy with biopsy is significantly more expensive, often $1,000 to $3,000 or more depending on the facility and your location, though insurance typically covers it when the blood test is positive and the procedure is medically indicated.
Direct-to-consumer lab orders and at-home kits range from about $50 to $150, but remember these only cover the initial screening step and may be less accurate than a full lab panel ordered through your doctor.