Could Someone Please Help With Entrolab Results?

[fox23]

Hello! Im very new to all of this and honestly feeling overwhelmed. Just received my results from Entrolab and was wondering if someone with more experience in all this wouldn't mind helping me analyze what exactly they mean. Any help/advice is very much appreciated! Here are my results:

B-1) Gluten Sensitivity Stool Panel

Fecal Anti-gliadin IgA 191 Units (Normal Range is less than 10 Units)

Fecal Anti-tissue Transglutaminase IgA 59 Units (Normal Range is less than 10 Units)

Quantitative Microscopic Fecal Fat Score 1048 Units (Normal Range is less than 300 Units)

TEST INTERPRETATION(S):

Interpretation of Fecal Anti-gliadin IgA: The level of intestinal anti-gliadin IgA antibody was elevated, indicative of active dietary gluten sensitivity. For optimal health; resolution or improvement of gluten-induced syndromes (mainly falling into six categories abbreviated as NAAAGS – neuropsychiatric, autoimmune, asthma, abdominal, glandular deficiencies/hyperactivity or skin diseases); resolution of symptoms known to be associated with gluten sensitivity (such as abdominal symptoms - pain, cramping, bloating, gas, diarrhea and/or constipation, chronic headaches, chronic sinus congestion, depression, arthritis, chronic skin problems/rashes, fibromyalgia, and/or chronic fatigue); and prevention of small intestinal damage and malnutrition, osteoporosis, and damage to other tissues (like nerves, brain, joints, muscles, thyroid, pancreas, other glands, skin, liver, spleen, among others), it is recommended that you follow a strict and permanent gluten free diet. As gluten sensitivity is a genetic syndrome, you may want to have your relatives screened as well.

For additional information on result interpretation, as well as educational information on the subject of gluten sensitivity, please see the "FAQ Result Interpretation," "FAQ Gluten/Food Sensitivity," and "Research & Education" links on our EnteroLab.com website.

Interpretation of Fecal Anti-tissue Transglutaminase IgA: The level of intestinal anti-tissue transglutaminase IgA antibody was elevated, indicative of an autoimmune reaction to the human enzyme tissue transglutaminase. This is almost always due to clinically significant gluten sensitivity. In rare cases, anti-tissue transglutaminase antibody appears in the absence of clinically significant gluten sensitivity, either as a marker of latent gluten sensitivity, as a consequence of an autoimmune reaction to a different stimulus (either dietary or otherwise), or possibly from liver disease. Tissue transglutaminase is an intracellular enzyme present in virtually all human tissues and organs, and is secreted extracellularly in response to tissue damage (such as occurs with trauma, surgery, pregnancy, infections, or inflammation-induced tissue damage). It is this extracellular release that allows the enzyme to become antigenic, especially when underlying gluten sensitivity is present. The fact that dietary gluten sensitivity so often induces a subsequent and secondary autoimmune reaction to this important human enzyme explains why autoimmune reactions and diseases so often accompany clinically significant gluten sensitivity.

Interpretation of Quantitative Microscopic Fecal Fat Score: A fecal fat score greater than or equal to 300 Units indicates that an abnormally high amount of dietary fat has passed undigested and/or unabsorbed into the stool. Malabsorption of dietary fat almost always is associated with malabsorption of all other nutrients as well (protein, carbohydrates, vitamins, etc.). When associated with gluten sensitivity, elevated fecal fat usually is due to gluten-induced small intestinal functional damage and subsequent malabsorption; this does not require there be villous atrophy present. However, deficient production of enzymes by the pancreas can also be associated with celiac disease or non-celiac gluten sensitivity with autoimmune attack on the pancreas, causing maldigestion and malabsorption of dietary fat and other nutrients. Some other causes of exocrine pancreatic insufficiency include chronic pancreatitis from any cause (alcoholism being the most common), pancreatic resection, pancreatic cancer, or common bile duct obstruction. Pancreatic insufficiency as the primary cause of fat malabsorption usually causes significant elevations of fecal fat values, usually into the moderate (600-1000 Units) or severe (>1000 Units) ranges.

To distinguish between small intestinal malabsorption and pancreatic maldigestion, a fecal pancreatic elastase test is necessary, which is now available from our laboratory.

Other possible causes of elevated fecal fat (steatorrhea) include - another inflammatory bowel disease (such as Crohn’s disease which can be associated with gluten sensitivity); deficiency in the production or secretion of bile salts; overgrowth of bacteria in the small intestine; diarrhea from any cause which can, in turn, cause dietary fat to rush through the intestine unabsorbed; consuming very large amounts of dietary fat; eating unabsorbable synthetic dietary fat substitutes; or taking “fat blockers;” and resection of the small intestine causing “short bowel syndrome” (if you have had an intestinal resection).

Any elevated fecal fat value should be rechecked in one year after treatment to ensure that it does not persist, because chronic fat malabsorption is associated with osteoporosis and other nutritional deficiency syndromes.

[IrishHeart]

I am sorry to tell you this, but Enterolab does not test for Celiac Disease. No leading celiac specialists or research centers use this lab or endorse/validate them.

 

Currently, there are no valid tests for "gluten sensitivity"

 

so I do not interpret anything from those results, except the suggestion to purchase more "tests"

 

and  I see a boatload of "possible OTHER diagnoses"  mentioned--because simply, these test results are not definitive at all.

 

You may well have something going on, but I am not sure this lab is going to give you the answers.None of us know your health history and none of us are doctors

 

Have you had a full celiac panel done?

 

See, this tells me they just want to sell you something more...

 

To distinguish between small intestinal malabsorption and pancreatic maldigestion, a fecal pancreatic elastase test is necessary, which is now available from our laboratory.

[dilettantesteph]

One thing that the tests say is that you have much higher than normal levels of the antibody to gliadin in you stool sample.  Fecal Anti-gliadin IgA 191 Units (Normal Range is less than 10 Units)

Gliadin is the part of gluten that celiacs react to which initiates the autoimmune response and makes them sick.

 

The validity of Enterolabs tests is disputed on this forum, but they are "a registered and fully accredited* clinical laboratory ".  I think I've heard that you can call them to discuss results.

[IrishHeart]

 "a registered and fully accredited* clinical laboratory ". 

 

This may be true, but it does not validate their testing for "gluten sensitivity" or "gluten sensitivity genes", at least according to

celiac researchers. I am just going by the Univ. of Chicago Celiac Center's FAQ section:

 

Why don’t you recognize tests (stool tests or otherwise) for non-celiac gluten sensitivity that are currently available through companies like Enterolab or Cyrex?

We only embrace tests that have endured rigorous scientific evaluations. So far, these tests have received no evidence-based support.

Enterolab has never successfully published anything on the accuracy of stool tests (nor have any other stool test manufacturers, to our knowledge) making it difficult to confirm the research results. Because of this, we must make our decisions based on what has been published; Harvard, UCSD, and the American College of Gastroenterology all agree that stool tests are simply not sensitive or specific enough methods in screening for celiac disease.

We can say therefore with confidence that the test currently being used by these labs is not good enough. In fact, while it is true that about 40% of people with proven gluten sensitivity have elevated AGA-IgG, it is also true that about 15-25% of the healthy individuals who have absolutely nothing wrong also have elevated AGA-IgG. Hence, about 60% of gluten sensitive people do not have elevated AGA-IgG (making the test not sensitive enough); and about 20% of normal, non-gluten sensitive people have elevated AGA-IgG for no apparent reason (making the test not specific enough).

Further reading: Open Original Shared Link at BMJ.com.

 

and I should probably also state that any opinions I have about Enterolab are based on those kinds of sources and do not reflect the opinions of "the forum" or the admin.  It's just me. Feel free to disregard.

I have no idea how everyone else feels about it.

[dilettantesteph]

Irishheart, you comments are valid.  I am really on the fence about this.  This test does not test for celiac disease.  They get many more positives than are obtained with intestinal biopsy.  They think that the reason for that is that they are catching the disease before it has progressed enough to be able to be detected by biopsy.  I really don't know.  It is something that would be unethical to try to prove with a double blind study.  There is more fecal testing done in Europe and interested people can research it further.  

 

Here is a link to start with: Open Original Shared Link

[IrishHeart]

You are right about European studies and as far as I can see from all the reading I do, Europe is way ahead of us in every arena regarding celiac and AI disease research.

 

I hope this trend continues so less people fall through the diagnostic cracks. It's not working as it is.

[GretaJane]

I would  not entirely dismiss enterolab results.  they may not be proven, but they are not disproven either.  I recommend appropriate testing before going gluten free, so you can get an official diagnosis for appropriate care and follow-up.

See guidelines below:

 

Posted by Open Original Shared Link at 03:04PM in blog - Open Original Shared Link: (0)

August 28, 2013

The American College of Gastroenterology released its first clinical guidelines to help doctors diagnose and manage their patients who have celiac disease. Dr. David A. Johnson, chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia, commented extensively online about the guidelines. His advice to his fellow physicians: “Beyond a little bloating and diarrhea, think outside the box. Celiac disease is grossly under-diagnosed, and we can all do better.”

Dr. Johnson provides the following synopsis of the ACG’s guidelines on celiac disease, suggesting that his medical colleagues take away these important points: 

1. Antigliadin antibody testing is no longer part of celiac screening. It should not be part of a doctor’s diagnostic testing for celiac disease.

2. IgA TTG testing should now be used - but NOT for patients who are IgA-deficient.

3. In patients who are IgA-deficient, doctors need to consider other testing, such as the DGP or the IgG TTG antibody. These test strategies are available in commercial laboratories.

4. Test results (blood tests and biopsy) can be misleading if the patient has been on a gluten-free diet. For these people, genetic testing and a gluten challenge are most helpful.

5. Genetic testing (HLA-DQ2 and HLA-DQ8) is helpful in select circumstances. If the patient is HLA-DQ2 and HLA-DQ8 negative, doctos can exclude the diagnosis of celiac disease.

6. Celiac disease has a high (10%) prevalence in Down syndrome. If a patient with Down syndrome is HLA-DQ2/8 negative, doctors can dismiss the diagnosis of celiac disease.

7. When doing a diagnostic endoscopy, multiple biopsies are key to diagnosis. Doctors should now biopsy the duodenal bulb, in addition to 4 or more biopsies from the second and third portions of the duodenum.

8. In some patients, abnormal liver enzymes may be the only manifestation of celiac disease apparent on routine testing. These patients are typically very responsive to a gluten-free diet (95 percent will resolve).

9. Doctors should involve a dietitian. Celiac patients need lifelong monitoring for vitamin and micronutrient deficiencies (iron, vitamin B12, vitamin D, folate, vitamin B6, and a variety of other micronutrients, such as copper, zinc and carnitine).

Source: Celiac Disease: New Guidelines for Diagnosis and Management. Medscape. David A. Johnson, MD. August 21, 2013.

 

good luck!!!!!!!

[nora-n]

Someone here posted about two-three years ago and was angry he later got diagnosed with microscopic colitis. His Enterolab tests had been positive for gluten sensitivity....and he could see no connection.

We answered, that is what the tests initially were developed for. But that Fine also saw that the tests were positive for many others. He could not dismiss the tests altogether, so he offered them to people. But they only test for gluten sensitivity. (and microscopic colitis)

[IrishHeart]

Yet, every leading celiac disease center says:

 

"Currently, there are no valid tests for gluten sensitivity"