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How accurate are blood-antibody tests?*

There are two classes of antibodies seen in untreated celiac disease. Antibodies directed against a fragment of gluten called gliadin, and antibodies directed against a particular tissue in the body itself. The two main areas in the body which can be attacked by its own antibodies are the aendomysial (the covering of muscle), and the reticulin ( the framework for kidney and liver), but there are others.

To conduct the test, 5ccs of blood is drawn from the patient, and the blood cells are removed. The gliadin test is usually an automated machine-read test, which means there is little room for interpretor error. However, currently in the USA there is no standard methods for conducting the test, or normal ranges for the results. The endomysial tests are more dependent on the experience and ability of a pathologist who looks at a pattern of staining produced by the patients serum on a slice of monkey esophagus. While this test is done in similar way in most labs, there are many differences in how the results are interpreted.

How good are these tests?

If all of the blood test results are positive a celiac disease diagnosis is 90% accurate. However, there are several circumstances in which the tests can be inaccurate. IGA and IGG are two different varieties of antibodies which are produced by most peoples immune systems. There is a different blood test for each of the antibodies. Of the two tests, the IGA gliadin and IGA endomysial tests are the most accurate. However, this test can become negative relatively quickly after going on a gluten-free diet (3-6 months), which can cause a false negative test result. The IGG is less specific, and can sometimes be positive in non-celiacs. Also, about 4% of celiacs have no IgA at all! For these reasons it is very important that both tests are done for an accurate diagnosis. The biopsy is still considered the "standard candle" to confirm a blood diagnosis, and give a 100% sure diagnosis.

For all tests for celiac disease it is necessary that one is on a gluten-containing diet, or false-negative test results could be given. Blood tests may also be useful in following up a known celiac and confirm that the diet is indeed free of large amounts of gluten. Also, because of the lack of standardization, keep in mind that blood test results may not be directly comparable from one lab to the next.

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49 Responses:

 
Ginger
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said this on
08 May 2008 12:14:40 PM PST
This is crazy...'a slice of monkey esophagus'. I had no idea they were killing monkeys for this. Also, I'm not willing to get on a gluten diet just to have some doctor tell me that I have celiac disease. That's just too risky for me. Although I do like the information about having a gluten test to see the levels of gluten getting into my diet that I am unaware of. Thank you for the information.

 
Dan Johnson
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said this on
24 Mar 2012 1:29:56 PM PST
I have no problems with a monkey being sacrificed for a human life or to get a chance at improving a human life. Until there is a better test, use the monkeys to improve our lives.

 
infinitely

said this on
05 Nov 2013 12:54:20 PM PST
That is a werid test and it is not even the only way to test for those specific antibodies. If your blood is A- you likely have it. I have Celiac's disease and my mother is having an ulcer and low blood sugars from it and is in a nursing home undiagnosed! Did you know that one in 22 people have Celiac if a family member has it. If no family member has it is one in 133 people who have it by chance. Doctors do not diagnose this! It could have killed my grandmother! DO NOT CHOOSE IGNORANCE PEOPLE ARE SUFFERING AND DYING FROM A DISEASE THAT OTHER PEOPLE DO NOT BELIEVE EXISTS! In the past if there were not bloating and pain there was no Celiac disease. Think about the people in nursing homes who have not been tested even though they have diabetes and ulcers, clear signs of this rare genetic disease common in certain blood lines. I am in great health but have anemia and low blood sugar! I have celiac it is that subtle! You can go your whole life and not notice the severe internal damage.

 
Jen
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said this on
05 Aug 2008 8:17:42 AM PST
About two years ago I had a celiac's test. I was told at the time it was negative. Come to find out, now they're saying I was positive for one of the antibodies but not the other. They're redoing the test. If I get the same result, should I push for some other type of test?

 
Maria
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said this on
07 Dec 2008 9:02:05 AM PST
There's no better indicator for what we need than our bodies own reaction to foods. I came up negative for antibodies, although which ones I am not aware. But when I get gluten in my food by accident, I am acutely aware of it. The immediate reaction is terrible gut pain, bloating and gas and later on my face is mottled by acne and inflammation. Clearly, these tests, although a god send for many, are not always a clear indicator of what is best for our health (as evidenced by the lack of a celiac diagnosis in my case). Some who are experiencing these symptoms but do not come up with antibodies should either look into the biopsy or just try the diet and see what happens. My livelihood was too large a price to pay for the convenience of eating whatever I wish.

 
Leticia
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said this on
22 Dec 2009 1:15:40 PM PST
I completely agree with you Maria!
My results keep coming back negative, but if I eat anything with gluten my face breaks out horribly and the gas and bloating with stomach pain are unbearable!

 
Letitia
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said this on
11 Jul 2013 8:33:45 AM PST
Liked your name as so close to mine. I have had two blood test positive but biopsy was negative. However, if I eat gluten like you I have bloating, gum bleeds, face swells and rash and gas. I live on rice with meats and veggies but I've been told that even rice is bad and oats even if they're gluten-free. Do you have any thoughts on this?

 
Beth
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said this on
15 May 2009 7:19:32 AM PST
I agree with Maria. It's not always so clear. My blood test came back positive but when they did the endoscopy there wasn't any visible damage to my small intestines, just severe redness (stomach & small intestines are suppose to be a pale pink color). The doc didn't even bother to take the biopsy. The doctors say that I don't have celiac but just an intolerance to gluten along with gastritis and lactose intolerant. If I eat anything with gluten/dairy I become so sick, you would think I have food poisoning. The doctors don't know much more about the disease then we do by researching it ourselves. They told me to be retested in a year or so, but clearly there won't be any signs because I am forced to eliminate gluten from my diet. I hope that with all the research they are doing on celiac disease, they can develop a more precise way to diagnose.

 
Jennifer
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said this on
27 Jun 2012 8:25:04 PM PST
Thanks for the HOPE! My 5 year old is going for an endoscopy in 2 weeks and I am nervous about the whole thing; but deep down I know it will be fine, and is the only 100% way to know for sure. Good luck on your gluten-free journey, thanks again.

 
Kelly
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said this on
25 Jul 2012 9:54:38 PM PST
Hi, my son is 12 and is going for a endoscopy in 2 weeks. It has got me ill. I hope all went well for your 5 year old.

 
Jan
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said this on
11 Sep 2009 5:46:38 PM PST
Very informative. I am going through a lot of G.I. problems right now and am having an upper G.I. done on Wednesday to try and find out what's going on. I cut gluten out of my diet about 3 weeks ago in an attempt to see if it would help. It HAS helped to some extent, but not totally. It DID eradicate my diarrhea issues, but not my pain and nausea (which could be cause by something else, I guess.) I am going to request that I be tested for Celiac Disease. I'm glad I read this though - I guess it means I need to eat a sandwich or some crackers or something the day before. Yuck. I DO miss the gluten foods - but have enjoyed being diarrhea-free. I accidentally ate something with gluten and sure enough, the trots came back. (sigh) Anyway - so I guess I'll eat a little gluten prior to the testing.

 
Patricia
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said this on
13 Nov 2009 7:57:41 AM PST
If you're still having minor symptoms after eliminating wheat, try eliminating soy or soybean oil too. This can be tedious (read labels on everything - jar spaghetti sauces, salad dressings, soups, butter spreads, chips, microwave popcorn, cereal, Worcestershire, etc.) but worth it! An article my sister sent me four years ago saved me because I was still not 100% well until reading it.

 
Sherry
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said this on
12 Apr 2011 5:53:45 PM PST
Not only wheat and soy can cause this type of distress, but also corn. I have the double whammy of no corn, no gluten. This makes eating very difficulty--but far better than ending up bent over in pain.

 
marylworth@yahoo.com
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said this on
09 Apr 2011 7:17:32 AM PST
Do you still have the article? Can you post it?

 
Michelle
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said this on
10 Dec 2009 3:10:02 PM PST
My son tested negative to celiac, but it runs in my husbands family, and my son severely reacts to gluten. His Pediactic Gastro. said that they now know that not all patients with celiac will even have a normal IGA response. He said follow the symptoms, not the test results. He also said that when you have celiac disease or a gluten sensitivity, you often become intolerant to soy and dairy (at least for awhile) until your stomach can heal. So, if when you cut out soy it is not helping much, cut out dairy too, or do a Total Elimination Diet for awhile. It sucks, but will help you get to the bottom of all the intolerances (which often cannot be found via a test).

 
Valerie
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said this on
20 Jan 2010 5:00:54 PM PST
I've been off gluten for six months now (and am feeling better). Now my MD wants me to do this bloodwork for celiac. She said three days of gluten beforehand--- does this sound like enough? Does anyone know?

 
Kara
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said this on
27 Jan 2010 3:59:45 AM PST
3 days of gluten is NOT enough. You have to be on a gluten diet for three MONTHS before getting an accurate diagnosis!

 
Simone
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said this on
06 Feb 2012 5:55:34 PM PST
My 6 year old daughter recently had her IGA blood test and the doctor advised she only needed a week for blood results but 6 weeks for biopsy. Having said that her bloods came back negative and the doctor has now wiped us from further tests saying shes not celiac.

 
Harvey Dessel
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said this on
12 Feb 2010 2:29:53 PM PST
This article and the blog were very helpful.

 
Meredith
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said this on
24 Mar 2010 1:31:10 PM PST
Very informative! My one year old daughter just had the biopsy and endoscopy test two days ago We are still waiting for results!

 
Paula
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said this on
21 May 2010 6:09:27 PM PST
This article was helpful - to a point. My 6 year old daughter has had tummy issues her whole life. To make a short story we had her blood tested & her antibody results were so high-off the chart- that her pediatrician said a biopsy wasn't necessary. She has celiac...period.
My husband has had the same symptoms nearly his whole life (that's why we ignored our daughter's for so long). He got his blood tested. His antibodies were also off the charts - and again we were told by his doctor that a biopsy isn't necessary. "he has Celiac".
We were told by 2 different doctors that a biopsy wasn't necessary. But all the research I've read said that the blood tests weren't 100% accurate.

Both my husband & daughter have been gluten free for 2 months now. My husband's digestive issues have all but disappeared. My daughter however, still has very loose stools, but she's only going once a day instead of several times a day. I"m torn between giving her system a little more time, or requesting that biopsy after all.

 
Dianna
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said this on
04 Oct 2010 11:52:15 AM PST
Paula - I found your comment to mean the most to our situation. My son was diagnosed with Celiac and also has "off the chart" blood tests for all 4 antibodies. The strange thing was that he is asymptomatic. I made the connection myself based on a tooth enamel defect that was found at the dentist office. We have all been tested (my husband, daughter and myself) and are awaiting the results. I am sure that I have it was well. Anyway, our doc was pushing the biopsy even though the blood tests were so compelling. We have chosen not to do that as my son just had his tonsils out and I do not want to put him through that right now. We have chosen to just eliminate the gluten altogether. I hope we have made the right choice. Did you ever have the biopsy done on your daughter?

 
Marta
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said this on
27 Oct 2010 4:46:41 PM PST
My GI doctor told me there is no way to diagnose just on the blood test. My doctor told me the same thing yours did. I was way off the chart as well...she told me I had celiac and to go on a gluten free diet. My GI doctor was very upset that she told me to go on the diet BEFORE I saw him. He said he HAS to do a biopsy to say I have celiacs.

 
Dana
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said this on
05 Aug 2011 2:08:32 PM PST
From what I understand, the blood test CAN be sufficient to determine a gluten intolerance, BUT in order to know if you have celiac disease, you need the biopsy. Celiac disease involves the deterioration of the villi which line the small intestine, and this is only confirmed through biopsy. However, you can have a significant gluten intolerance and not have celiac disease. Celiac is just one of the many possible side effects of eating gluten if you are intolerant. the body does not produce antibodies against something unless it is harmful to you. Therefore, the positive blood work could be considered enough to determine your gluten intolerance, and spare yourself or your little ones the expense and trauma of an endoscopy. Unless of course you really want to have the celiac diagnosis, eliminating gluten will provide amazing health benefits either way to the gluten intolerant individual.

 
Jodi
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said this on
27 Jan 2012 11:47:56 AM PST
So my question in my case is if my blood test came back barely positive but my endoscopy came back negative should I stop eating gluten? My doctor told me that if I don't have any symptoms that it is ok to eat it. Your thoughts????

 
Rose
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said this on
21 Jul 2010 7:47:29 AM PST
Great website for someone new to celiac disease. I just got my blood test results and think it says I do not have celiac Even though I still think I do and will begin a gluten-free diet. Results were (ttg)ab,iga <3; iga,serum 141. The thing that is throwing me is the iga serum.

 
Tim
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said this on
15 Aug 2010 8:54:24 AM PST
False negatives and false positives don't bode well for someone with tendencies toward hypochondria. When I do the gluten elimination diet strictly I feel better but it could be a placebo effect. That's why the blood tests are appealing to me; so I can take my double-guessing self out of the loop, but if they aren't accurate enough to provide greater certainty that the elimination diet then what's the point? Well, anyway this article answered several questions for me including the need to go back on gluten prior to the test and your insightful comments provided a ballpark figure for how long to go back on before testing.

 
Tim
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said this on
15 Aug 2010 9:06:05 AM PST
Does anyone else get rhinitis (stuffy runny nose and sneezing) during their reactions or is it strictly gastro-intestinal for you?

 
Ayrnn
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said this on
18 Aug 2010 3:51:55 PM PST
I have been having terrible gastrointestinal problems. Had an ultrasound and blood work. Nothing turned up. Since, someone mention perhaps gluten is the problem. I cut it out for 3 days, and the tummy troubles are gone. I have had rhinitis all my life, post nasal drip all night long, been on allergy pills of every type. I am hoping with a little more time on the gluten free diet, this will be alleviated. Keep me posted on your end. PS - going today for the blood work for the antibody to gluten. I am hoping 3 days off of gluten will be ok for an accurate reading. Although, prior to my gluten free diet, I could barely eat anything...that lasted more than a month!

 
Jan
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said this on
19 Nov 2010 3:33:46 PM PST
I get a runny nose as soon as I eat anything with gluten in it. I went on an elimination diet for 4 weeks because I was suffering from diarrhea, skin rashes, canker sores, gas, etc. The elimination diet cleared all of my symptoms. In trying things afterward, I got an immediate reaction to bread, so now I am off gluten completely.

I don't think you need a doctor to tell you that you are gluten intolerant. They seem to have a protocol for "diagnosing" someone with celiac that includes the biopsy and tests, but the disease is on a continuum. Not everyone will test positive for every test, but if eliminating gluten helps, you should do it!

 
Wanda
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said this on
26 Dec 2010 5:54:15 PM PST
Tim,
I get a runny nose immediately when eating something with gluten in it- I mean within 2-3 minutes! It is quite amazing and annoying at the same time!

 
Dawn Penland
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said this on
16 May 2011 2:14:03 PM PST
I get a runny nose the morning after I eat gluten.

 
Mere
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said this on
10 Jul 2011 9:05:36 PM PST
I get a very itchy nose (externally, like the skin on the end of my nose), bloodshot itchy eyes, nosebleeds, I had erythema nodosum, headaches, acne, and about 20 other symptoms of the approximate 300. This all in addition to the stomach pain, and other gastro issues.

 
Gabriella
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said this on
26 Oct 2011 10:27:09 AM PST
No, but in my reaction, I get extremely itchy and red and patchy skin particularly on my chest and face and extreme acne flair ups within minutes of consumption among the gastrointestinal effects. I read that "food allergies" particularly cause your symptoms and they can be celiac-related so I would try to avoid completely the foods that cause that reaction in you as this is a sign that your body is not taking to well to it.

 
Ashley P
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said this on
18 Sep 2010 7:34:36 PM PST
This article helps a lot. I have gastrointestinal problems, dermatitis rashes that appear on my foot every 3-4 ish months, and geographic tongue. I'm more at risk for celiac b/c I also have Hashimoto's thyroiditis, but the one antibody test(IA-2) came back negative. I'm thinking my autoimmune disease might be affecting the test results, and am going gluten free to be sure.

 
Tami
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said this on
23 Sep 2010 12:43:37 PM PST
A biopsy of your rash may be all you need. They say it is 100% sure indicator for celiac. I'd ask your dermatologist about it.

 
Erika
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said this on
11 Dec 2010 11:36:00 AM PST
I am 19 and since I was little I have had stomach issues and chronic constipation. Now more recently I am having severe acne issues, and now am missing periods. I had a colonoscopy about a year ago and everything was fine. I went to a gynecologist and she tested my thyroid levels and my general physician said an antibody level was high but the thyroid function was okay. He sent me for blood work to test for celiac because I have a family history on my mom's side. He called with the results today and said "everything was normal". I am so frustrated because all he is doing is giving me medicine to help me go to the bathroom but they either make me sick or don't work at all, the only thing that works is Exlax. I want to push for an upper g.i. but I don't want to waste the time and money if i really don't have it. I don't know what else to do and it seems like since he can't figure out whats wrong he is just giving up. What do I do? Please help.

 
Rose
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said this on
05 Apr 2012 9:27:57 PM PST
Hi Erika, have you tried to see a natural medicine doctor? A year ago, I had a very severe acne issue along with GI problems and Grave disease. The doc told me to increase the dosage of Oroxine and take some contraceptive pills but I did not want to do so. I read a few books from Dr Sandra Cabot regarding the thyroid and I have gained a better understanding about the thyroid and the autoimmune diseases. I started drinking 500ml of the vegetable juice and take Zinc and Selenium daily. After 6 months, my skin was a lot better and now I have a glowing skin that everyone is jealous ofl. I used to be a meat lover but since last year, I became almost a "herbivore". I only eat Atlantic salmon, soy products, legumes, fruits and vegetables and opt for a processed sugar, gluten and dairy free diet. I have so much of energy given that I only sleep 5-6 hours everyday. I am a lot happier, healthier and stronger now. It's true that "you are what you eat"! For a good health always! PS: The books that I have read recently are "Your Thyroid Problems solved", "Raw Juices can save your life" by Dr Sandra Cabot and "Eat to live" by Sue Radd and Dr Kenneth Setchell.

 
Pola
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said this on
20 Mar 2011 11:49:58 AM PST
I think that a diet based on Raw food is the best for everybody. And sure for celiac people. Try it. It's natural and its according to our physiology. Blessings to all.

 
Tootie
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said this on
28 Mar 2011 2:15:39 PM PST
There are 3 stages of injury to the intestinal lining with gluten sensitivity/celiac disease - Marsh 1, Marsh 2, and Marsh 3. Marsh 1 shows inflammation only. Marsh 2 shows tips of the villi missing, and Marsh 3 shows the villi are gone. Only Marsh 3 is diagnostic of celiac disease.

Blood tests correlate with celiac disease (Marsh 3) 90% of the time. With anything less, the blood tests correlate only 30% of the time. Having normal blood tests may mean you don't have celiac disease (defined as total loss of the intestinal villi), but it doesn't rule out gluten sensitivity (anything less than total loss of the villi).

There is a new lab, Cyrex, that does some novel testing for gluten senstivity/celiac disease, but it is new. I haven't had any experience with it.

The best test is an elimination diet and see what happens. If you feel better, you are sensitive to the food, whether it's gluten or something else. If you have been off of gluten for a while, it may not be a good idea to re-challenge. It can take months for the inflammation to calm down again.

 
Kathy
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said this on
16 Aug 2013 12:51:02 AM PST
Great read through all these posts, I have suffered from bloating for years on and off, I have recently come off gluten and it's been 6 days now and I feel great! No bloating, my doctor has given me the forms to get a blood test, but I am reluctant to go back on gluten for two weeks, prior to the test as I have felt so much better. How important is it to have it diagnosed 'celiac' or not? If you are just 'intolerant,' will you eventually go through the marsh 2 and 3 stages? or is it just if you are celiac??

 
Stephanie
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said this on
25 Apr 2011 8:06:21 AM PST
I've been having problems with my stomach for two years now. My doctor thought it was my gallbladder but, i did an ultrasound and they said it was all fine. My doctor said it was my birth control, she took me off and gave me something else, but as always it didn't work. I'm having stomach pains, bloating, extreme gas, and getting nausea. Well, i got the blood test done the other day because, my friend has it and she told me it sounds just like her problems. Well, they both came back negative and I want to get a endoscopy done to see. But, if i go two days without eating gluten products my stomach starts to feel a little better but when i go right into eating again it starts bloating, stomach pains, extreme gas, and nausea.

 
Amy
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said this on
06 Dec 2011 11:24:30 AM PST
My total SIgA (saliva) was 6 (depressed- normal is (25-60)) and Gliadin Ab, SIgA (Saliva) was 1 (positive is >15). Which is a negative result. Could my SIgA Gliadin be lower since my SIgA is very low? (I have no other known conditions). Should I try to get a blood test? Is that more accurate than saliva? Where to go from here?

 
Maria
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said this on
10 Dec 2011 12:40:03 PM PST
Hi everyone. I am recent to this celiac and am from a developing country...so little gluten free diet options here. My igA is 118 on a retest after I was on a gluten free diet for 6 months. Previously it was 284 (normal is less en 10). My igG was 604 but it is normal this time (4). So my doc says I don't need a biopsy. My tests are sufficient. AND now with this repeat test he has put me on steroids for a week...confusing.

 
Allie
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said this on
30 Jan 2012 8:34:43 PM PST
I recently had a blood test done due to painful stomach aches and it came back positive for celiac. I am going to have the biopsy done on Wednesday (two days from now) I am just wondering, will I fall asleep with the pill they are going to give me? Or will I still be awake? I don't know what the pill is called, but I really don't want to be awake! Also am I still allowed to eat things with gluten in it? Or should I be on a gluten-free diet until they do the test?

 
PJ Johnson
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said this on
13 Mar 2012 10:07:20 PM PST
I had horrible swelling throughout my body, fainting spells, gas bloating and stomach cramps. My results were all positive and high including the biopsy. If I accidently get gluten I know it right away too with horrible cramps.

 
Moncia

said this on
18 Dec 2013 11:40:10 AM PST
I am newly diagnosed celiac and have been gluten free for about a month and a half. I was in hospital for 12 days and then took 2 weeks after that off work. I also had a pretty bad colon infection and colitis. My diarrhea is now almost gone unless I am very stressed but my abdomen is still like someone who is 6 months pregnant and I am still in a lot of pain at times. I was wondering how long does it take for the swelling to go away?

 
Susan
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said this on
18 May 2013 3:23:49 PM PST
My doctor says to me, "Doing a full panel for celiac" per my request. No, he did not. They tested for IGA and Immuno A, and that's it. Hardly a "full panel." Test was negative with a result of "2" (considered negative), but I've been almost fully gluten-free for 2 months per the doctor's suggestion, and feel so much better it's like a miracle. My dad died of a gastro cancer and based on his symptoms, I would bet he had celiac disease. I'm going to get a cheek swab for the gene test to be sure. I'm really tired of having to advocate for proper healthcare - why do we pay doctors so much when they can't do the right thing?

 
Anna
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said this on
12 Nov 2013 10:42:09 AM PST
Yes, I agree with you. Why do we pay doctors so much when they don't seem to try to keep up with current studies but instead just "go with the flow" of all the other doctors. I feel as if doctors don't "think" anymore. And if a patient ever suggests what they think may be the cause, the doctors just make you feel like you are crazy! I am an Occupational Therapist that has worked in healthcare for 20 years and I must say that I have become very distrustful of our healthcare system. There are great doctors out there but you have to search for them!




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