Rectal Challenge

There is only one reliable means of identifying celiac disease during the first six months after beginning a gluten-free diet. It is an experimental protocol called the rectal challenge. This test was devised by Dr. Michael N. Marsh and his associates, and it is really a very simple, less invasive, economical, and the most accurate test for celiac disease. It requires a computer, a scanner, some plastic instruments, gluten slurry, and a very special computer program. The patient arrives at the clinic. The gluten slurry is placed in the rectum and patients are advised to hold it as long as they can and are sent on their way. After four hours the patient returns and a rectal biopsy is taken with a plastic instrument. The tissue is then scanned into the computer for evaluation by the software. This process identifies celiac disease and only celiac disease. Unlike a jejunal biopsy, the evaluation is objective and the results can not be confused with milk protein allergy, or intestinal infection. Neither does the patient have to wait for a positive response to the diet to ensure they do or do not have celiac disease. Unlike serological testing for endomysium antibodies (EMA) or tissue transglutaminase (tTg) antibodies, the rectal challenge does not overlook between 7% and 15% of cases due to IgA deficiency and other reported weaknesses in blood tests. Finally, there are no false positives in the rectal challenge, as sometimes happens with EMA and tTg

It is difficult to imagine why the rectal challenge is not now the gold standard for the diagnosis of celiac disease.