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Do Elevated Anti-tissue Transglutaminase Levels Indicate Celiac Disease?


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#1 sunnybabi1986

 
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Posted 02 December 2009 - 08:01 PM

I got my results back from enterolab a couple of weeks ago and had elevated Anti-gliadin IgA and anti-tissue transglutaminase IgA levels. I carry a celiac gene and a gluten sensitive gene.

I assumed that I had a 50/50 shot of having either a sensitivity or having celiac, since I've had positive results after being gluten free for 6 weeks. However, I was reading a book today about celiac and it said that elevated Anti-gliadin IgA levels indicate a gluten sensitivity while elevated Ttg levels indicate celiac, since it is an auto immune response.

Do I have this straight?:

Anti-gliadin IgA levels measure whether or not your body is creating antibodies against gluten.

Anti-tissue transglutaminase IgA levels measure whether or not your body is creating antibodies against your own tissue, which is an autoimmune response.

Since I had elevated levels of both, this indicates that I have more than a sensitivity, that I actually have celiac disease, and when I eat gluten, my body is creating antibodies to attack the gluten and to attack my own tissue, damaging my intestines.

I'm still trying to figure this all out...do I have it right? Thanks!!

Janie
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Gluten Free since October 2009

If evolution really works, how come mothers only have two hands?" - Milton Berle

"Life is 10 percent what happens to me and 90 percent how I react to it."--Lou Holtz

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#2 homemaker

 
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Posted 03 December 2009 - 03:41 AM

I got my results back from enterolab a couple of weeks ago and had elevated Anti-gliadin IgA and anti-tissue transglutaminase IgA levels. I carry a celiac gene and a gluten sensitive gene.

I assumed that I had a 50/50 shot of having either a sensitivity or having celiac, since I've had positive results after being gluten free for 6 weeks. However, I was reading a book today about celiac and it said that elevated Anti-gliadin IgA levels indicate a gluten sensitivity while elevated Ttg levels indicate celiac, since it is an auto immune response.

Do I have this straight?:

Anti-gliadin IgA levels measure whether or not your body is creating antibodies against gluten.

Anti-tissue transglutaminase IgA levels measure whether or not your body is creating antibodies against your own tissue, which is an autoimmune response.

Since I had elevated levels of both, this indicates that I have more than a sensitivity, that I actually have celiac disease, and when I eat gluten, my body is creating antibodies to attack the gluten and to attack my own tissue, damaging my intestines.

I'm still trying to figure this all out...do I have it right? Thanks!!

Janie

Great Questions!!!
I would love to hear the answers as well....MY results are similar to yours...
My IgA Anti-gliadin was a 9 and due to the presence of symptoms they suggested gluten free diet, and my ttg was a 10...but mine showed very high malabsorption...
I have one Celiac Gene (HLA_DQ-0201) and One Gluten Sensitive Gene (HLA_DQ2-0202)
which when combined together are quite the high risk combination....
I have wondered about the ttg levels vs Anti-gliadin IgA levels...and have wanted to ask the same questions...
I hope someone out in Celiac Land will lead us in the right direction...
  • 0
Constipation, Gas, Bloating, Abdominal Pain, Ataxia, Brain Fog, Joint Pain Headaches
Bloodwork Negative
Went gluten free 10/02/09
Immediate and Positive intestinal improvement with improvement in headache frequency
Enterolab results 11/23/09 (after one month gluten free)
Fecal Anti-tissue Transglutaminase IgA 10 units
Fecal Anti-gliadin IgA 9 units
Fecal Fat 1267 units
HLA-DQB1 Allele 1: 0201
HLA-DQB1 Allele 2: 0202
Serologic equivalent: HLA-DQ 2,2 (Subtype 2,2)

#3 ravenwoodglass

 
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Posted 04 December 2009 - 04:50 AM

It doesn't matter whether you label it gluten sensitivity or celiac. Both require a strict adherence to the diet. Both cause antibodies that attack your system. IMHO the terms gluten senstivity and gluten intolerance need to be abolished. Many think unless the label says celiac they can get away with small amounts of gluten. They can't.
  • 0
Courage does not always roar, sometimes courage is the quiet voice at the end of the day saying
"I will try again tommorrow" (Mary Anne Radmacher)


celiac 49 years - Misdiagnosed for 45
Blood tested and repeatedly negative
Diagnosed by Allergist with elimination diet and diagnosis confirmed by GI in 2002
Misdiagnoses for 15 years were IBS-D, ataxia, migraines, anxiety, depression, fibromyalgia, parathesias, arthritis, livedo reticularis, hairloss, premature menopause, osteoporosis, kidney damage, diverticulosis, prediabetes and ulcers, dermatitis herpeformis
All bold resoved or went into remission with proper diagnosis of Celiac November 2002
Some residual nerve damage remains as of 2006- this has continued to resolve after eliminating soy in 2007

Mother died of celiac related cancer at 56
Twin brother died as a result of autoimmune liver destruction at age 15

Children 2 with Ulcers, GERD, Depression, , 1 with DH, 1 with severe growth stunting (male adult 5 feet)both finally diagnosed Celiac through blood testing and 1 with endo 6 months after Mom


Positive to Soy and Casien also Aug 2007

Gluten Sensitivity Gene Test Aug 2007
HLA-DQB1 Molecular analysis, Allele 1 0303

HLA-DQB1 Molecular analysis, Allele 2 0303

Serologic equivalent: HLA-DQ 3,3 (Subtype 9,9)

#4 homemaker

 
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Posted 04 December 2009 - 05:05 AM

It doesn't matter whether you label it gluten sensitivity or celiac. Both require a strict adherence to the diet. Both cause antibodies that attack your system. IMHO the terms gluten senstivity and gluten intolerance need to be abolished. Many think unless the label says celiac they can get away with small amounts of gluten. They can't.

Ahhh You have answered my puzzlement....
That BOTH gluten sensitivity and Celiac produce antibodies that attack your system...
I did not know that!
That was my confusion...I thought somehow that only Celiac caused high ttg....
THANKS! :)
  • 0
Constipation, Gas, Bloating, Abdominal Pain, Ataxia, Brain Fog, Joint Pain Headaches
Bloodwork Negative
Went gluten free 10/02/09
Immediate and Positive intestinal improvement with improvement in headache frequency
Enterolab results 11/23/09 (after one month gluten free)
Fecal Anti-tissue Transglutaminase IgA 10 units
Fecal Anti-gliadin IgA 9 units
Fecal Fat 1267 units
HLA-DQB1 Allele 1: 0201
HLA-DQB1 Allele 2: 0202
Serologic equivalent: HLA-DQ 2,2 (Subtype 2,2)

#5 jkr

 
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Posted 04 December 2009 - 05:22 AM

I didn't think an elevated ttg could mean gluten intolerance. I thought it was just an indicator of celiac.
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#6 cruelshoes

 
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    We've heard nothing at all about the growing tomato menace..

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Posted 04 December 2009 - 06:36 AM

First and foremost, Enterolab cannot diagnose Celiac Disease, nor do they claim to. Stool testing is not an accepted form of testing for celiac disease.

http://celiacdisease...Qs28Aug2009.pdf


11. Are stool tests acceptable to screen for or diagnosis celiac disease or gluten intolerance or gluten sensitivity?

No. There is currently no published evidence supporting the usefulness of any stool tests in
screening for celiac disease or any forms of gluten intolerance. In fact, there is currently no
medically accepted test—genetic, stool, blood or otherwise—that is considered valid in
screening for gluten intolerance or gluten sensitivity.


Secondly, there are different classes of antibodies. The TtG may indicate an autoimmune response (the body attacking itself), while the Antigliadin IgA may indicate a reation to the gluten itself.

http://americancelia...ease/diagnosis/

What are the different antibody tests available? Can there be errors in testing?

The blood tests can be divided into 2 different types of antibodies: those which are “anti-gluten”, and those that “anti-self”. The “anti-gluten” antibodies are the anti-gliadin IgG and IgA. Ig stands for “immunoglobulin” or “antibody”. The “anti-self” antibodies are anti-endomysial IgA and anti-tissue transglutaminase IgA. The tissue transglutaminase IgA antibody is often abbreviated as “tTG”. Each antibody test varies widely in its sensitivity and specificity for predicting whether the disease is present in any individual. It must be remembered that NO test in medicine is correct 100% of the time in each person!

There are also several conditions which may yield false negative antibody results. A false negative means that the patient actually has the disease, but the test result is negative. One of the conditions that may give a false negative result is Immunoglobulin A or IgA deficiency. If a patient has a low total IgA level, the antibodies may be falsely low. This is why I always recommend that a patient have a total IgA level drawn at the same time the antibody testing is done. Young children may not make the some of the “anti-self” antibodies, as it takes a somewhat mature immune system to make them. So in a young child, antiendomysial antibody, or the TTG antibody, can have false negative results. An inexperienced lab can misread the anti-endomysial IgA test, which requires someone to read a slide through a special microscope. It is possible that a celiac patient could have a positive antibody test at one lab, and a negative test at another. This is because different labs may use different commercial test kits, which vary in their sensitivity and specificity. And lastly, a person has to be ingesting gluten at the time the antibodies are drawn. A gluten-free diet will make the antibody tests negative.

Let’s discuss the different antibodies and what the strengths and weaknesses are for each.

Antigliadin antibodies
The antigliadin antibodies IgG and IgA recognize a small piece of the gluten protein called gliadin.
These antibodies became available during the late 1970’s and were the first step towards recognizing CELIAC DISEASE as an autoimmune disorder. Antigliadin IgG has good sensitivity, while antigliadin IgA has good specificity, and therefore their combined use provided the first reliable screening test for CELIAC DISEASE. Unfortunately, many normal individuals without CELIAC DISEASE will have an elevated antigliadin IgG, causing much confusion among physicians. The antigliadin IgG is useful in screening individuals who are IgA deficient, as the other antibodies used for routine screening are usually of the IgA class. It is thought that 0.2-0.4% of the general population has selective IgA deficiency, while 2 to 3% or more of celiacs are IgA deficient.

If a patient’s celiac panel is only positive for antigliadin IgG, this is not highly suggestive for CELIAC DISEASE if the patient has a normal total IgA level, corrected for age. Younger children make less IgA than older children and adults. A markedly elevated antigliadin IgG, such as greater than three to four times the upper limit of normal for that lab, is highly suggestive of a condition where the gut is leakier to gluten. This can happen in food allergies, cystic fibrosis, parasitic infections, Crohn’s disease, and other types of autoimmune GI diseases. These antibodies may also be slightly elevated in individuals with no obvious disease.

A strength of the antigliadin antibodies is that they are ELISA tests. ELISA is an abbreviation for “enzyme-linked immunosorbent assay”. This is a rapid immunochemical test that involves an enzyme, which a protein that causes a biochemical reaction. An ELISA test also involves an antibody or antigen. ELISA tests are utilized to detect substances that have antigenic properties, primarily proteins, such as gliadin. The importance of an ELISA test is that is it rapid, inexpensive, and run by a machine. Thus the results are independent of observer variability. The TTG test is also an ELISA test. This is in contrast to the antiendomysial IgA, where a slide has to be made, and a person has to look at it through a microscope. These are more prone to human error.

Antiendomysium antibodies
The antiendomysial IgA antibody is an excellent screening test for CELIAC DISEASE, with both a high sensitivity and specificity. It is considered the gold standard of antibodies. However, the subjective nature of this test (someone still needs to look at the slide under a microscope) may lead to false negative values and unacceptable variability between laboratories. This antibody was discovered in the early 1980’s, and rapidly gained use as part of a screening “celiac panel” by commercial labs in combination with antigliadin IgG and IgA. Its major drawbacks are that it may be falsely negative in young children, in patients with IgA deficiency and a lesser degree of villous atrophy, and in the hands of an inexperienced laboratory.

Tissue transglutaminase antibodies or TTG
Since tTG had been first described as the autoantigen of celiac disease in 1997, it has been utilized to develop innovative diagnostic tools. The tTG IgA ELISA test is highly sensitive and specific. The tTG assay correlates well with EMA-IgA and biopsy. However, it represents an improvement over the antiendomysial antibody assay because it inexpensive, rapid, is not a subjective test, and can be performed on a single drop of blood using a dot-blot technique. One negative aspect of the TTG antibody is that it can be falsely positive in a patient who has another autoimmune condition. TTG false positivity has been described in patients with both type I diabetes and autoimmune hepatitis. Theoretically, it can also be falsely positive in other autoimmune disease.


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-Colleen
Dx 8/05 via bloodwork and biopsy (total villous atrophy)
13-year old son Dx 11/05 via bloodwork and biopsy
Daughters (16 and 5) have tested negative via bloodwork

A woman is like a tea bag - you never know how strong she is until she gets in hot water. - Eleanor Roosevelt

#7 homemaker

 
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Posted 04 December 2009 - 01:35 PM

I was already aware that Enterolab does not claim to diagnose Celiac Disease....
It is my humble opinion that current accepted testing for Celiac Disease is
woefully inadequate....The Gold Standard diagnosis will not be Gold Standard for long....
  • 0
Constipation, Gas, Bloating, Abdominal Pain, Ataxia, Brain Fog, Joint Pain Headaches
Bloodwork Negative
Went gluten free 10/02/09
Immediate and Positive intestinal improvement with improvement in headache frequency
Enterolab results 11/23/09 (after one month gluten free)
Fecal Anti-tissue Transglutaminase IgA 10 units
Fecal Anti-gliadin IgA 9 units
Fecal Fat 1267 units
HLA-DQB1 Allele 1: 0201
HLA-DQB1 Allele 2: 0202
Serologic equivalent: HLA-DQ 2,2 (Subtype 2,2)

#8 GottaSki

 
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Posted 04 December 2009 - 02:20 PM

It is my humble opinion that current accepted testing for Celiac Disease is
woefully inadequate....The Gold Standard diagnosis will not be Gold Standard for long....


Well said and I whole-heartedly agree! I first heard "Gold Standard" from my Celiac Specialist. He is a wonderful physician given what is currently understood about Celiac Disease.

In my never to be humble opinion -- Our current medical system needs to somehow remove the insurance companies from the driver's seat -- now if I could only come up with how that could be accomplished I'd truly have an opinion that should be read by all!
  • 0

-Lisa

Undiagnosed Celiac Disease ~ 43 years

3/26/09 gluten-free - dignosed celiac - blood 3/3/09, biopsy 3/26/09, double DQ2 / single DQ8 positive

10/25/13 - MCAD

Health history since celiac diagnosis became too long -- moved to the "about me" section of my profile

My children and I all have multiple copies of the genes for Celiac Disease, along with large variety of symptoms/resolution gluten-free

Current tally from me, three kids and two grands: 4 diagnosed with Celiac Disease, 2 NCGS

Get PROPERLY tested BEFORE REMOVING GLUTEN.

ALWAYS independently research health related information found on internet forums/blogs.

"LTES" a Gem :)


#9 cruelshoes

 
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    We've heard nothing at all about the growing tomato menace..

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Posted 04 December 2009 - 02:49 PM

I was already aware that Enterolab does not claim to diagnose Celiac Disease....
It is my humble opinion that current accepted testing for Celiac Disease is
woefully inadequate....The Gold Standard diagnosis will not be Gold Standard for long....


I have no opinion on Enterolab per-se. I am confident that testing methods for Celiac will evolve. I don't think Dr. Fine's tests will be filling in for the bloodwork/biopsy anytime soon, however. He seems to be quite content to do business outside of mainstream medicine. More power to him. Everybody has to take their own path. I personally hate the term "gold standard." I think it is very polarizing. I get that it is the medically accepted term, but it just makes people with and without it get into fights, KWIM? We have lots of people in my support group on both sides of the equation, and we have all gotten results from removing gluten from our diets. Apologies to the OP for the topic drift.


My purpose for replying to the original poster is to clarify the following: Antigliadin IgA antibodies indicate an anti-gluten response. TtG antibodies indicate an anti-self response. You can have one or the other or both, and still not be able to consume gluten.
  • 0
-Colleen
Dx 8/05 via bloodwork and biopsy (total villous atrophy)
13-year old son Dx 11/05 via bloodwork and biopsy
Daughters (16 and 5) have tested negative via bloodwork

A woman is like a tea bag - you never know how strong she is until she gets in hot water. - Eleanor Roosevelt

#10 Gemini

 
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Posted 07 December 2009 - 01:25 PM

I have no opinion on Enterolab per-se. I am confident that testing methods for Celiac will evolve. I don't think Dr. Fine's tests will be filling in for the bloodwork/biopsy anytime soon, however. He seems to be quite content to do business outside of mainstream medicine. More power to him. Everybody has to take their own path. I personally hate the term "gold standard." I think it is very polarizing. I get that it is the medically accepted term, but it just makes people with and without it get into fights, KWIM? We have lots of people in my support group on both sides of the equation, and we have all gotten results from removing gluten from our diets. Apologies to the OP for the topic drift.


My purpose for replying to the original poster is to clarify the following: Antigliadin IgA antibodies indicate an anti-gluten response. TtG antibodies indicate an anti-self response. You can have one or the other or both, and still not be able to consume gluten.


Your clarification was spot on but elevated tTg may also indicate another autoimmune disease present other than Celiac Disease. Hashimoto's thyroid disease and liver disease may also be indicated with elevated tTg levels.

To the original poster...if you went through Enterolabs to have testing done and came back with these results, I would highly suggest blood screening for Celiac Disease, especially since you carry a gene for it. Of course, that means eating the dreaded gluten again for awhile...... :(
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#11 cruelshoes

 
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    We've heard nothing at all about the growing tomato menace..

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Posted 07 December 2009 - 02:13 PM

Your clarification was spot on but elevated tTg may also indicate another autoimmune disease present other than Celiac Disease. Hashimoto's thyroid disease and liver disease may also be indicated with elevated tTg levels.


You are correct, which is another reason why Enterolab's tests cannot diagnose celiac disease. TtG can be elevated in quite a few other conditions, and not just Celiac - even some that are not autoimmune.
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-Colleen
Dx 8/05 via bloodwork and biopsy (total villous atrophy)
13-year old son Dx 11/05 via bloodwork and biopsy
Daughters (16 and 5) have tested negative via bloodwork

A woman is like a tea bag - you never know how strong she is until she gets in hot water. - Eleanor Roosevelt

#12 sunnybabi1986

 
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Posted 07 December 2009 - 06:36 PM

To the original poster...if you went through Enterolabs to have testing done and came back with these results, I would highly suggest blood screening for Celiac Disease, especially since you carry a gene for it. Of course, that means eating the dreaded gluten again for awhile...... :(


Yikes, you couldn't pay me to eat gluten again. I've tried a couple of times, just to see for myself whether or not it truly is the problem, and have become very sick each time I eat gluten or accidentally cross contaminate. There's no way I would go back to eating gluten for a test when I'm finally starting to feel better...for me, gluten brings painful stomach cramping, gas, intense nausea, and debilitating exhaustion. My reactions are enough diagnosis of a gluten problem for me. :)

Yay for finally starting to get my life back a bit! :D
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Gluten Free since October 2009

If evolution really works, how come mothers only have two hands?" - Milton Berle

"Life is 10 percent what happens to me and 90 percent how I react to it."--Lou Holtz

#13 homemaker

 
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Posted 08 December 2009 - 03:44 AM

Good for you! I second that! I would never go back to gluten...I have embraced a gluten free life totally...My body tells me gluten is not my friend, I only used Enterolab testing as a guidepost to direct my own decision making process.

I know that Enterolab does not make a diagnosis...BUT...again...it was used as a tool in my own decision making process...it helped confirm for me what my body had been trying to tell me...

I do not go around telling people that I have Celiac disease...but I do tell them my body does not like gluten...that I get sick...and really? Isn't that all we need to know...

Who knows when all is said and done where the future of Celiac Testing will take us...
But I am sure of this...it will be more sophisticated and definitive...What we have today will be considered archaic and antiquated....
  • 0
Constipation, Gas, Bloating, Abdominal Pain, Ataxia, Brain Fog, Joint Pain Headaches
Bloodwork Negative
Went gluten free 10/02/09
Immediate and Positive intestinal improvement with improvement in headache frequency
Enterolab results 11/23/09 (after one month gluten free)
Fecal Anti-tissue Transglutaminase IgA 10 units
Fecal Anti-gliadin IgA 9 units
Fecal Fat 1267 units
HLA-DQB1 Allele 1: 0201
HLA-DQB1 Allele 2: 0202
Serologic equivalent: HLA-DQ 2,2 (Subtype 2,2)




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