Sign in →

Test ID: TSTGP Tissue Transglutaminase Antibodies, IgA and IgG Profile, Serum

Reporting Name

Tissue Transglutaminase Ab, IgA/IgG

Useful For

Evaluating patients suspected of having celiac disease, including patients with compatible clinical symptoms, patients with atypical symptoms, and individuals at increased risk (family history, previous diagnosis with associated disease, positivity for HLA DQ2 and/or DQ8)


Screening for dermatitis herpetiformis, in conjunction with endomysial antibody test


Monitoring response to gluten-free diet in patients with dermatitis herpetiformis and celiac disease

Clinical Information

Celiac disease (gluten-sensitive enteropathy, celiac sprue) results from an immune-mediated inflammatory process following ingestion of wheat, rye, or barley proteins that occurs in genetically susceptible individuals.(1) The inflammation in celiac disease occurs primarily in the mucosa of the small intestine, which leads to villous atrophy. Common clinical manifestations related to gastrointestinal inflammation include abdominal pain, malabsorption, diarrhea, and/or constipation. Clinical symptoms of celiac disease are not restricted to the gastrointestinal tract. Other common manifestations of celiac disease include failure to grow (delayed puberty and short stature), iron deficiency, recurrent fetal loss, osteoporosis, chronic fatigue, recurrent aphthous stomatitis (canker sores), dental enamel hypoplasia, and dermatitis herpetiformis. Patients with celiac disease may also present with neuropsychiatric manifestations including ataxia and peripheral neuropathy and are at increased risk for development of non-Hodgkin lymphoma. The disease is also associated with other clinical disorders including thyroiditis, type I diabetes mellitus, Down syndrome, and IgA deficiency.


Individuals with family members who have celiac disease are at increased risk of developing the disease.(2) Genetic susceptibility is related to specific human leukocyte antigen (HLA) markers. More than 97% of individuals with celiac disease in the United States have DQ2 and/or DQ8 HLA markers, compared to approximately 40% of the general population. For this reason, HLA-DQ2 and HLA-DQ8 are considered genetic risk factors for celiac disease and are required, but not sufficient, for the disease process to occur.


A definitive diagnosis of celiac disease requires a jejunal biopsy demonstrating villous atrophy.(3) Given the invasive nature and cost of the biopsy, serologic and genetic laboratory tests may be used to identify individuals with a high probability of having celiac disease. Because no single laboratory test can be relied upon completely to establish a diagnosis of celiac disease, individuals with positive laboratory results may be referred for small intestinal biopsy, thereby decreasing the number of unnecessary invasive procedures (see Celiac Disease Diagnostic Testing Algorithm). In terms of serology, celiac disease is associated with a variety of autoantibodies, including endomysial antibody (EMA), tissue transglutaminase (tTG), and deamidated gliadin antibodies.(4) Although the IgA isotype of these antibodies usually predominates in celiac disease, individuals may also produce IgG isotypes, particularly if the individual is IgA deficient. The most sensitive and specific serologic test is tTG IgA isotype , in individuals who produce sufficient total IgA. For individuals who are IgA deficient, testing for tTG and deamidated gliadin IgG antibodies is required.


The treatment for celiac disease is maintenance of a gluten-free diet. In most patients who adhere to this diet, concentrations of associated autoantibodies decline, which is sometimes also accompanied by reconstitution of the small intestinal villi. In most patients, an improvement in clinical symptoms is observed. For evaluation purposes, all serologic tests ordered for the diagnosis of celiac disease should be performed while the patient is on a gluten-containing diet. Once a patient has initiated the gluten-free diet, serologic testing may be repeated to assess the response to treatment. In some patients, it may take up to 1 year for antibody titers to normalize. Persistently elevated results suggest poor adherence to the gluten-free diet or the possibility of refractory celiac disease.


See Celiac Disease Diagnostic Testing Algorithm for the recommended approach to a patient suspected of celiac disease.


An algorithm is available for monitoring the patient's response to treatment, see Celiac Disease Routine Treatment Monitoring Algorithm.


Positive results for tissue transglutaminase (tTG) IgA or IgG antibodies are consistent with a diagnosis for celiac disease and possibly for dermatitis herpetiformis. For individuals with moderately to strongly positive results, a diagnosis of celiac disease is possible and a small intestinal biopsy should be considered to confirm the diagnosis.


Negative results for tTg IgA and IgG antibodies indicate a decreased likelihood of celiac disease.


A decrease in the concentration of tTG IgA or IgG may begin after initiation of a gluten-free diet and could indicate a response to therapy.

Profile Information

Test ID Reporting Name Available Separately Always Performed
TTGA Tissue Transglutaminase Ab, IgA, S Yes Yes
TTGG Tissue Transglutaminase Ab, IgG, S Yes Yes

Report Available

Same day/1 to 4 days

Day(s) Performed

Monday through Saturday

Clinical Reference

1. Rubin JE, Crowe SE: Celiac disease. Ann Int Med. 2020;172:ITC1-ITC16

2. Lebwohl B, Rubio-Tapia A: Epidemiology, presentation, and diagnosis of celiac disease. Gastroenterol. 2021;160:63-75

3. Rubio-Tapia A, Hill ID, Kelly, CP, et al: American College Gastroenterology clinical guidelines: Diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108:656-676

4. Penny HA, Raju SA, Sanders DS: Progress in the serology-based diagnosis and management of adult celiac disease. Exp Rev Gastroenterol Heptatol. 2020;14:147-154

Method Name

Enzyme-Linked Immunosorbent Assay (ELISA)

Specimen Type


Ordering Guidance

Cascade testing is recommended for celiac disease. Cascade testing ensures that testing proceeds in an algorithmic fashion. The following cascades are available; select the appropriate one for your specific patient situation.

-CDCOM / Celiac Disease Comprehensive Cascade, Serum and Whole Blood: complete testing including HLA DQ

-CDSP / Celiac Disease Serology Cascade, Serum: complete serology testing excluding HLA DQ

-CDGF / Celiac Disease Gluten-Free Cascade, Serum and Whole Blood: for patients already adhering to a gluten-free diet


To order individual tests, see Celiac Disease Diagnostic Testing Algorithm

Specimen Required

Collection Container/Tube: 

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Specimen Minimum Volume

0.4 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 21 days
  Frozen  21 days

Reference Values


<4.0 U/mL (negative)

4.0-10.0 U/mL (weak positive)

>10.0 U/mL (positive)

Reference values apply to all ages.



<6.0 U/mL (negative)

6.0-9.0 U/mL (weak positive)

>9.0 U/mL (positive)

Reference values apply to all ages.

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

86364 x 2

LOINC Code Information

Test ID Test Order Name Order LOINC Value
TSTGP Tissue Transglutaminase Ab, IgA/IgG 35681-6


Result ID Test Result Name Result LOINC Value
TTGA Tissue Transglutaminase Ab, IgA, S 46128-5
TTGG Tissue Transglutaminase Ab, IgG, S 56537-4


If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Client Test Request (T728) with the specimen.

Mayo Clinic Laboratories | Neurology Catalog Additional Information:

mml-Behavioral, mml-Movement-Disorders, mml-Neuroimmunology, mml-Spinal-Cord, mml-Neuro-ophthalmology