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Genetic Testing A Must?


mamamonkey

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mamamonkey Rookie

Hi everyone! I am new here. So, here's the back story. I had diarrhea, pain after eating, fatigue, and abdominal bloating for 4 years after the birth of my son. I had my gallbladder removed when he was 10 weeks old due to gallstones from pregnancy; so, I chalked all my GI symptoms up to no gallbladder.

Fast forward to this past May 2012. I decided to try going gluten free in a last ditch attempt to get off of Topamax that I had to take for migraines. Within 2 days of going gluten free, my GI symptoms significantly improved. After a month, I had dropped a pant size in bloat. I was able to get off of Topamax. (I know, I know, I should have gotten tested then)

In December, I had some additional issues that ended me up seeing GI. She then decided that I could possibly have celiac since all of my symptoms dramatically improved with cutting gluten. Serology was negative (I wasn't eating gluten). EGD showed mild inflammation, possibly suggestive of partially treated celiac (I ate gluten daily the week before my test).

So, now, I would like to have the genetic testing done. Since it requires prior authorization from my insurance, the GI is now saying that with my symptoms, symptom resolution off gluten, and the biopsy results that I don't need the genetic testing.

My question is, how hard should I push for this? I mean, is it worth changing docs over?


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kareng Grand Master

This was just posted on the University of Chicago Celiac center's Facebook page:

"True or false? Genetic screening is the best way to know for sure if someone has celiac disease."

"The University of Chicago Celiac Disease Center Answer: False. Genetics are often times not even included in the diagnostic process. 30% of the U.S. has the genes for celiac disease, but <5% have it become active. In addition, if the genes aren't present then celiac can all but be ruled out as the cause of symptoms.

Like · Reply · 6 · 6 hours ago"

mamamonkey Rookie

Thank you Karen. :)

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    • trents
      Let me hasten to add that if you will be undergoing an endoscopy/biopsy, it is critical that you do not begin efforts to reduce gluten beforehand. Doing so will render the results invalid as it will allow the small bowel lining to heal and, therefore, obscure the damage done by celiac disease which is what the biopsy is looking for.
    • Scott Adams
      This article, and the comments below it, may be helpful:    
    • Scott Adams
      That’s a really tough situation. A few key points: as mentioned, a gluten challenge does require daily gluten for several weeks to make blood tests meaningful, but negative tests after limited exposure aren’t reliable. Dermatitis herpetiformis can also be tricky to diagnose unless the biopsy is taken from normal-looking skin next to a lesion. Some people with celiac or DH don’t react every time they’re exposed, so lack of symptoms doesn’t rule it out. Given your history and family cancer risk, this is something I’d strongly discuss with a celiac-experienced gastroenterologist or dermatologist before attempting a challenge on your own, so risks and benefits are clearly weighed.
    • Greymo
      https://celiac.org/glutenexposuremarkers/    yes, two hours after accidents ingesting gluten I am vomiting and then diarrhea- then exhaustion and a headache. see the article above- There is research that shows our reactions.
    • trents
      Concerning the EMA positive result, the EMA was the original blood test developed to detect celiac disease and has largely been replaced by the tTG-IGA which has a similar reliability confidence but is much less expensive to run. Yes, a positive EMA is very strong evidence of celiac disease but not foolproof. In the UK, a tTG-IGA score that is 10x normal or greater will often result in foregoing the endoscopy/biopsy. Weaker positives on the tTG-IGA still trigger the endoscopy/biopsy. That protocol is being considered in the US but is not yet in place.
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