Get email alerts Get Celiac.com E-mail Alerts  




Celiac.com Sponsor:
Celiac.com Sponsor:




Ads by Google:






   Get email alerts  Subscribe to FREE Celiac.com email alerts

Dgp Question....
0

5 posts in this topic

We got results of my 12-yr-old daughter's blood work today. Everything was in the normal ranges except for the DGP, which was 37 units (<20 antibody not detected)(>or=20 antibody detected). Her CBC showed no abnormalities or deficiencies, so the doctor said he recommends eating gluten-free, but he will not diagnose her with celiac. He believes that she does not have full-blown celiac disease since there is no indication of malabsorption. Since the DGP is so specific, is it enough to go on to diagnose? Or is an endoscopy required as well?

I originally took her in because I suspected spots on her legs to be DH. They could not do a biopsy on the day we were there because of scheduling, so we set it up for today. Of course, the lesions healed beyond the point of getting a positive result (on adjacent skin), so I cancelled the biopsy. With no DH and no endoscopy, but a positive DGP, is the doc correct in NOT diagnosing her?

0

Share this post


Link to post
Share on other sites


Ads by Google:

It is my personal opinion that he should do the endoscopy with a positive DGP, even with normal bloodwork and tTG. The DGP is very specific for celiac disease (i.e., nothing else that we know of elevates it, unlike the tTG). Dr. Rodney Ford (world eminent pediatric GI - here in Christchurch) believes that every child who has an elevated DGP will eventually develop celiac, whether or not they actually have it at the time of testing. I heard him speak on this subject about a family with one child with celiac and two with elevated DGP but negative biopsies. Within two years, both these other two children had celiac disease. So it is possible that the endoscopy would not turn up positive either, but I think it should enter into the picture. Many celiacs with negative tTG's have tested positive on biopsy.

So to answer your other question, if your doctor does not plan to follow up on this result, I would either wait until she has an active skin lesion and get it biopsied, or take her straight gluten free. I personally do not believe it is worth continuing to give her rat poison so the doctor can become convinced. He was supposed to pay for his own education :P Not all doctors are Dr. Rodney Ford :(

0

Share this post


Link to post
Share on other sites

She may not have the worst symptoms of celiac disease yet, but that doesn't mean she wouldn't develop worsening symptoms over time if she continues to eat gluten. Her doctor isn't thinking quite right. He needs to consider the idea of preventative care once in awhile. Does he take his car to the shop when the check engine light comes on? Or wait until the engine falls out before talking to a mechanic? Grrr is a legal word here, so Grrr!

0

Share this post


Link to post
Share on other sites

I was diagnosed with just blood work so I'm biased on simply accepting a positive blood test as indicating celiac. Those DGP tests are fairly specific to celiac disease as far as I know.

If the doctor is implying that her disease hasn't progressed much yet, then great! Although I have no idea how he can tell that from the blood work.... either way, she should go gluten-free once her testing is complete. Good luck.

0

Share this post


Link to post
Share on other sites

I just excerpted this for another poster, so thought I would pop it in here, too. :)

http://drrodneyford.com/extra/documents/279-gliadin-antibody-confusion-same-name-different-test.html

The old gliadin test. In the 1990s, the gliadin antibody test was developed. Although most celiacs had a positive IgG-gliadin antibody test, high levels of this antibody were found in about 10% of the normal population. Consequently, gliadin testing was considered non-specific” from the point of view of diagnosing celiac disease. Mistakenly, this led to IgG-gliadin being maligned as a useless and non-specific test .

Gluten sensitivity. The reality, however, is that an elevated IgG-gliadin antibody specifically means that the person is immunologically reacting to gluten. International research, including my own, has demonstrated that high gliadin anybody levels are frequently associated with clinical disease without the gut damage of celiac disease. This is now known as non-celiac gluten sensitivity, or the gluten syndrome.

Because of the poor predictive value of IgG-gliadin antibodies to detect celiac disease, this old gliadin test has been widely abandoned in the medical community – to the extent that most laboratories do not offer to do this test. But this is about to change.

DGP. This new deamidated gliadin peptide (DGP) antibody is the next big step along the journey. It is more sensitive and specific than EMA or tTG for the diagnosis of celiac disease. Unfortunately, its name is now being confused with the early old gliadin test.

Nicknames

Shortening names is universal, we call these nicknames. Whenever I am in Australia, I introduce myself as Rodney, but my friends call me Rod .

The same name strategy is being used for the DGP test. Instead of its full name, it has been shortened to the gliadin test – the identical name for the old gliadin test. But they test for very different things:

The new DGP gliadin test accurately indicates the gut damage of celiac disease.

The old IgG-gliadin antibody test indicates immunological reaction to gluten, and can help diagnose the gluten syndrome.

This is how to interpret what these gliadin antibodies mean:

A positive old test (IgG-gliadin antibody) usually means gluten sensitivity.

A positive new test (DGP-IgG and DGP-IgA) means celiac disease.

A negative old test usually means that gluten is unlikely to be a problem.

A negative new test means that celiac disease is unlikely at the time of the test, but it does not rule out gluten sensitivity.

0

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
0

  • Forum Statistics

    • Total Topics
      104,144
    • Total Posts
      919,569
  • Topics

  • Posts

    • Thanks Stephanie & Gemini for the info. that the 4 of 5 doesn't apply to children. I wasn't aware of that until now. 
    • I think the posters above have given you very good information and I will throw in my 2 cents worth.  I am surprised that they did not test her DGP IgA also.  I am sure that would have been positive.  They switched off with antibody classes and usually they do both tests for both antibodies.  IgA is more specific to Celiac but the IgG is also useful.  The testing shows your daughter is producing antibodies to the gluten in her diet. (DGP IGG). THe tTg shows positive for some damage or inflammation. You know........your daughter is only 4.  She hasn't been on the planet or eating gluten that long. It can take years for enough damage to occur for it to be able to be found on biopsy.  I would say it is highly likely that this is Celiac, especially with her symptoms. But because the damage hasn't graduated to bad enough yet, they won't diagnose her. I think you need to do what others have said and get all copies of testing and find someone else who will take a look and give a diagnosis, especially if they have you do a dietary trial and her symptoms go away.  That might be the only recourse if you want faster proof. I know I would want faster.  I would not really be happy if I thought I had to keep feeding her something that was making her sick.  If you keep her on gluten long enough, the diarrhea will probably show up. BTW.........the criteria mentioned regarding diagnosis does not apply to kids.  I know it's silly and stupid but most leading Celiac specialists do not go by this criteria for kids.......adults only.  Keep that in mind because it might come up.  You could recognize it but they might not. Have you considered gene testing, to help bolster a diagnosis? As far as false positives go, it's the other way around. False negatives happen more frequently than many people think.  It's a recurring theme here.  With her symptoms, which is what I had, a bloated belly and tummy aches are telling.  Have they tested her for lactose intolerance?  That can cause similar symptoms, although it sure won't raise those 2 blood tests.  Keep looking for Celiac because there are many red flags here.
    • This 4 out of 5 criteria does not apply to children. I was never given a reason why, but it isn't.     That said, you may try to get a second opinion from another GI who may be willing to give her a firm dx.  We were in your boat 6 years ago and while I'm sure I'll get slammed for it, I wish we had kept gluten in our kiddos diet till he scoped positive for a variety of reasons.  Again, even family is different and you have to find what is best for you!
    • Mnoosh, I had swollen lymph nodes prior to celiac dx and for a while after going gluten free. My neck as well as groin. The groin ones were the worst. Guess what? All gone! It's hard to recall a time line & consider that everyone is different but I think mine completely resolved within a year.  You've been given great information. Just breathe and then again, breathe. You're going to be fine. 
    • It is the only thing you have eaten, so it can't be anything else?  I eat it with no issues so I am not sure how you can be certain that is the problem.  All I am saying is that its sort of "your word against mine and the company's word".  
  • Upcoming Events

  • Blog Entries

  • Recent Status Updates

  • Who's Online (See full list)

  • Member Statistics

    • Total Members
      61,176
    • Most Online
      1,763

    Newest Member
    Red Butt in hemet
    Joined