EnteroLab Testing May Help Identify Gluten Sensitivity

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EnteroLab, a laboratory in Dallas, tests for non-celiac gluten sensitivity by looking for antibodies to gluten in your stool. Although the tests offered by EnteroLab haven't been validated by outside laboratories or through peer-reviewed research, many people who have used the testing (including both doctors and patients) believe that it accurately identifies gluten sensitivity.

EnteroLab offers its services direct to consumers.

Those who have been unable to persuade their physicians to order celiac disease tests (or who have gotten negative results from their tests) appreciate the fact that they don't need to go through their physicians to order the EnteroLab tests; they can order the tests themselves.

However, because EnteroLab's tests haven't been independently verified, it's not clear whether the testing offers information you can really trust about your body's reactions to the protein gluten (and other allergenic proteins in food).

EnteroLab Technology Looks for Gluten Antibodies in Your Stool, Not Blood

The gluten sensitivity tests offered by EnteroLab look for antibodies to gluten in the stool (fecal antigliadin-IgA antibody) and for antibodies to the tissue transglutaminase enzyme produced by the body when gluten is ingested (fecal anti-tissue transglutaminase-IgA antibody). The tests are patented by EnteroLab and in use only at EnteroLab's Texas facility.

Gastroenterologist Dr. Kenneth Fine, the laboratory's medical director and a former Baylor University Medical Center attending physician, developed the tests to serve as a more sensitive way of detecting damage from gluten before it became widespread in the body. His theory is that the antibodies will present in the intestines and spill over into the stool long before they'll appear in your bloodstream.

According to Dr. Fine, the stool test will pick up gluten sensitivity before it's progressed to the point of destroying your intestinal lining. "Because the antibodies produced as the result of gluten sensitivity are mainly secreted into the intestine rather than the blood, analyzing stool turns up many more positive tests than blood tests. It is only when the immune reaction has been present for long periods of time and/or the process is far advanced that antibodies are produced in quantities sufficient to leak into the blood," he says on his website.

EnteroLab also offers another advantage over celiac blood testing: You don't need to be eating gluten for the test to be accurate. According to Dr. Fine, even tiny amounts of gluten in your diet can lead to a positive result if you're gluten-sensitive.

Several Tests Offered to Detect Gluten Sensitivity

EnteroLab offers four different tests designed to detect gluten sensitivity and reactions to gluten in the body:

  • Gluten sensitivity stool test: This looks for fecal antigliadin IgA antibodies, which Dr. Fine says represent an immune system reaction to gluten in the diet.
  • Tissue transglutaminase stool test: This looks for fecal anti-tissue transglutaminase IgA antibodies, which Dr. Fine says indicate a reaction of the immune system to the tissue transglutaminase enzyme produced by the body when gluten is ingested, leading to an autoimmune reaction that may destroy the intestinal lining or other tissues in the body.
  • Quantitative fecal fat microscopy: This test measures the amount of the fat present in the stool; according to Dr. Fine, large amounts of fat in the stool indicate problems with digestion of fat and other nutrients, meaning damaged intestines.
  • Gene test for genes linked to celiac disease and gluten sensitivity: This test looks for the presence of one or more of the genes that have been linked to celiac disease, gluten sensitivity and other autoimmune diseases.

EnteroLab also offers stool tests to look for sensitivity to oats, soy, casein, chicken eggs, and yeast, as well as a stool test to detect chronic or acute colitis.

Insurance Likely Won't Cover EnteroLab Testing

Customers pay for their chosen tests up-front. A complete gluten sensitivity stool panel costs $279, a gene test (which involves a cheek swab, not a stool sample) costs $149, and a single stool test for gluten sensitivity costs $99. Various panels of tests are available to test for other food sensitivities.

To order the tests, you visit the EnteroLab website and pay for your chosen tests. EnteroLab then sends a stool collection kit for you to fill and return to the lab. Analysis usually takes a few weeks.

Because EnteroLab offers its services direct to the consumer, most insurance companies will not reimburse for the testing. In addition, because Dr. Fine's testing methods have not been accepted by most celiac disease researchers (and he has yet to publish results of his research in a mainstream medical journal), most doctors discount EnteroLab stool testing as a way to diagnose non-celiac gluten sensitivity.

EnteroLab testing also cannot diagnose celiac disease; for that, you generally need positive celiac blood tests and an endoscopy showing damage to your intestines.

Does EnteroLab's Testing Accurately Identify Gluten Sensitivity?

It's true that many people receive positive results from their EnteroLab testing, indicating gluten sensitivity. However, those people wouldn't have sought out the testing if they didn't already suspect they had a problem with gluten, so a high rate of positives would be expected. And many people do report receiving negative results, as well.

Few doctors accept positive EnteroLab test results as proof of anything, and no physician I know of will accept EnteroLab testing to diagnose celiac disease (to be fair, Dr. Fine doesn't claim to diagnose celiac disease — just gluten sensitivity).

However, you don't need a doctor's permission to eat gluten-free. Many people turn to EnteroLab testing after they have gotten the brush-off from physicians over their symptoms, or received negative celiac disease test results but still get symptoms from consuming gluten.

While there is not yet any published research proving the validity of the EnteroLab tests, it may provide the encouragement some folks need to go gluten-free. At the moment, asking someone to try the gluten-free diet and seeing if it helps improve symptoms is the only way physicians have to diagnose non-celiac gluten sensitivity.

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