While the current standard tests of serology and conventional histology are usually adequate to reach a diagnosis of CD, there are patients whose tests are equivocal and diagnostic uncertainty remains. Several novel diagnostic approaches have been undertaken. The deposition of IgA antibodies in close proximity to TG2 in the small intestine has shown promise as a way of defining early or potential CD in patients who are seropositive but lack any of the usual histological markers for CD. Recent work from Finland on IgA-TG2 autoantibody deposition in the small intestine in such patients shows promise in delivery of an early prediction of development of CD. However, this is currently experimental and the methodology requires tissue sections frozen in liquid nitrogen.124 (link) Another diagnostic method meriting further evaluation is EmA assay in the culture medium of small intestinal biopsies.125 (link)
126 (link) Other investigators have reported their findings using new techniques associated with endoscopy to enhance the diagnosis of CD. These include confocal microscopy, high-resolution magnification endoscopy, optical band imaging127 (link) and optimal coherence tomography. These novel techniques are still limited by availability, tolerability and cost.98 (link) However, the immersion technique and dye enhancement in which the endoscopist instills water or a contrast dye (for example, indigo carmine or methylene blue) into the bowel lumen, with or without the assistance of magnification endoscopy, enhancing the visualisation of the villus128 (link) can be readily used and improves visualisation of villi, thus increasing the sensitivity for detection of villous atrophy.98 (link)