Do These Lab Results Mean Celiacs?

[evansmommy]

My 3 year old recently had a celiac disease comprehensive panel work up done due to symptoms correlated with celiacs - I received the results via email with no discussion from the doctor to know what is going on...

Deamidated gliadin ABS, IGA - 4

Deamidated gliadin ABS, IGG - 2

T-transglutaminase (ttg) IGA - <2

T-transglutaminase (ttg) IGG - 13

Endomysial antibody IGA - negative

immunoglobulin a,qn,serum - 113

Please help decipher!

[psawyer]

Welcome to our world.

Well, it is hard to say with just the numbers you shared. Each lab has a "reference range" for each test, and they vary from lab to lab. But I will take a stab based on general knowledge.

The last number, total serum iGa, is a validation on the other results. If it is low, then other iGa tests are likely to be a false negative. 113 is probably in the reference range for normal. That would validate the first and third results. The second and fourth measure iGg--

a different type of antibody. I am not familiar with the fifth test.

Overall, to me (and I am not qualified to diagnose), It does not seem to be an indication for celiac disease. However, blood screening in young children is known to be hit and miss. I would see if you can talk to the doctor about this. If there are celiac disease symptoms then an endoscopy with biopsy may be indicated even with apparently negative blood tests.

[evansmommy]

I appreciate you quick response! I have tried to copy and paste email with reference ranges if it makes any difference to what you think, but if it's not celiacs, would it be a sensitivity?

DEAMIDATED GLIADIN ABS, IGA 4 0-19 UNITS Final 01

NEGATIVE 0 - 19 WEAK POSITIVE 20 - 30 MODERATE TO STRONG POSITIVE >30

DEAMIDATED GLIADIN ABS, IGG 2 0-19 UNITS Final 01

NEGATIVE 0 - 19 WEAK POSITIVE 20 - 30 MODERATE TO STRONG POSITIVE >30

T-TRANSGLUTAMINASE (TTG) IGA <2 0-3 U/ML Final 01

NEGATIVE 0 - 3 WEAK POSITIVE 4 - 10 POSITIVE >10 . TISSUE TRANSGLUTAMINASE (TTG) HAS BEEN IDENTIFIED AS THE ENDOMYSIAL ANTIGEN. STUDIES HAVE DEMONSTR- ATED THAT ENDOMYSIAL IGA ANTIBODIES HAVE OVER 99% SPECIFICITY FOR GLUTEN SENSITIVE ENTEROPATHY.

T-TRANSGLUTAMINASE (TTG) IGG 13 0-5 U/ML High Final 01

NEGATIVE 0 - 5 WEAK POSITIVE 6 - 9 POSITIVE >9

ENDOMYSIAL ANTIBODY IGA NEGATIVE NEGATIVE Final 01

IMMUNOGLOBULIN A, QN, SERUM 113 44-189 MG/DL Final 01

[BlessedMommy]

What is the reference range for the Ttg results? If it is 10, than that 13 would be positive. If the reference range was 20 than it would be a negative.

[evansmommy]

The ref range went to a 9 and he was a 13... I just don't know which of these labs is the celiac indicator. I did try to copy and paste the lab work with ref. ranges to help me decipher this better. Thank you all!

DEAMIDATED GLIADIN ABS, IGA 4 0-19 UNITS Final 01

NEGATIVE 0 - 19

WEAK POSITIVE 20 - 30

MODERATE TO STRONG POSITIVE >30

DEAMIDATED GLIADIN ABS, IGG 2 0-19 UNITS Final 01

NEGATIVE 0 - 19

WEAK POSITIVE 20 - 30

MODERATE TO STRONG POSITIVE >30

T-TRANSGLUTAMINASE (TTG) IGA <2 0-3 U/ML Final 01

NEGATIVE 0 - 3

WEAK POSITIVE 4 - 10

POSITIVE >10

.

TISSUE TRANSGLUTAMINASE (TTG) HAS BEEN IDENTIFIED

AS THE ENDOMYSIAL ANTIGEN. STUDIES HAVE DEMONSTR-

ATED THAT ENDOMYSIAL IGA ANTIBODIES HAVE OVER 99%

SPECIFICITY FOR GLUTEN SENSITIVE ENTEROPATHY.

T-TRANSGLUTAMINASE (TTG) IGG 13 0-5 U/ML High Final 01

NEGATIVE 0 - 5

WEAK POSITIVE 6 - 9

POSITIVE >9

ENDOMYSIAL ANTIBODY IGA NEGATIVE NEGATIVE Final 01

IMMUNOGLOBULIN A, QN, SERUM 113 44-189 MG/DL Final 01

[BlessedMommy]

Have you been referred to a pediatric GI doctor for an endoscopy yet? 

[evansmommy]

To be honest... Mommy rant... I received these results via email with no call or direction, which is why I have so many questions and no idea what's going on!

[nvsmom]

Its hard to be left with no direction, and particularly annoying when doctors tell us not to google stuff. 

 

That tTG IgG looks positive so there is a good chance that it is celiac disease. The following report discusses the specificity of the tTG IgG - specificity is the percentage of positive tests caused by celiac disease - and it states the SP of the tTG IgG is 95%... He has a 5% chance that it is NOT celiac disease. Open Original Shared Link False positive tTG IgA tests  are caused by crohn's, colitis, diabetes, thyroiditis, chronic liver disease, or a serious infection; I imagine the same holds true for the ttG IgG... Would any of those health problems apply to your son and have caused a false positive?

 

It is common for a celiac to not be positive in all the tests run, that's why they run so many.  The sensitivity of the tests vary between 40 (or lower) up to 95%.... Some of the tests can miss the majority of celiacs so running a bunch of tests is your best bet.  Even the endoscopic biopsy can miss as many as 1 in 5 celiacs.  Celiac tests are far from perfect. This report (pages 10-12) discusses the tests some more: Open Original Shared Link

 

Non-celiac gluten sensitivity (NCGS) will never cause a false positive tTG IgA, tTG IgG, or EMA IgA.  Those tests indicate that damage is being done (or attempted to be done) to the endomysial layer of the intestines. NCGS does not do damage to the intestines although it does cause a host of other problems.

 

Some doctors think that the AGA (anti-gliadin antibody) tests may indicate NCGS but that is not universally accepted.   Some suspect the same may be true of the DGP tests in absence of positive ttG tests, but that's not widely accepted either. Open Original Shared Link

 

To me, a positive is a positive and he probably has celiac disease.  Think of the tests like a pregnancy test - false positives are not very common but false negatives happen more often.  If you doubt it is celiac disease, I would suggest pushing for an endoscopic biopsy of the small intestine, with at least 6 samples taken.  The biopsy can miss celiacs, but it detects damage 80% of the time.

 

If the doctors won't do the biopsy, or the findings are inconclusive, start the gluten-free diet anyways.  Do the tests again then give the diet 6 months (some symptoms take months to resolve), go lactose free (50% of celiacs are lactose intolerant when diagnosed), and then retest and re-evaluate his health (keep a food and symptoms journal in the meantime). If he is doing better, then you have your answer.  If his ttG IgG goes down, that's another answer there (celiacs test results drop on the gluten-free diet).  

 

Oops, almost forgot about the genetic tests.  97%of celiacs have the DQ2 and / or the DQ8 genes.  If he does not have those genes then it is less likely to be celiac disease.  Celiac is genetic, so if celiac disease is strongly suspected, then the rest of the family should be checked, and rechecked every couple of years in the case of a negative result.  First degree relatives have a 1 in 10 chance of developing celiac disease.

 

Best of luck in whatever you decide to do. Welcome to the boards.