Can the stomach bug elevate TTG?

[CeliacMommaX2]

My 7 year old just had her TTG checked again (we were hoping to try gluten-free oats again for her).  It was 55!  (Up from 21 in October).  She was diagnosed 3 years ago and we've had trouble getting her TTG down.  (only got to 14, which <15 was considered negative).  We are super strict, gluten free household, homeschoolers and never eat out.  I'm trying to figure out why her TTG is 55 now!  She did have a stomach bug 10 days prior to her lab check (the whole family had it, so it wasn't gluten!).  Could that have elevated her labs?  Her GI doc wants to repeat her EGD now... I hate to put her through that again- anyone else have thoughts on if that's a good idea?

I'm just at a loss and don't know which way to go now.  Any thoughts are appreciated!

[Gemini]

Has your daughter been screened for the other AI diseases that can happen so often with Celiac?  There are some that will raise tTg and keep it elevated until they are rooted out and treated. 

I have no idea if a stomach virus can elevate tTg.  I have never heard of it but that doesn't mean it can't happen.  You may have to do a repeat endo just to see if she is healed, then you can possibly rule out whether she is ingesting gluten or not.  Has she had a DGP repeated?  That would actually let you know whether this is happening.  They are supposed to run both for compliance and healing information but you know how that goes.

[cyclinglady]

I would do the endoscopy.  Here is why.  My DGP IgA was very elevated last year after a gluten exposure (not even sure what I consumed, but I had the flu, a cold, and a tooth infection.  Four months after my exposure. I was still off the charts.  By summer, I was still struggling with symptoms (GERD, acid reflux, autoimmune hives).  MY GI pushed for the endoscopy,  but I declined.  By November, my symptoms persisted and I had been on the Fasano diet!  My DGP IgA was still elevated.  I was so discouraged.   In January, I did the endoscopy.  My small intestine has healed.  Lots of healthy villi could be visually seen and my GI went deep.  My biopsies confirmed the healing.  I did find out that my GERD was due to autoimmune chronic gastritis which is not responding obviously to my gluten free diet.  My symptoms for that ebb and flow, and like many autoimmune issues, it is beyond my control.  

What did I learn?  That celiac antibodies testing is not great for aftercare.  I even discussed this with Melinda Dennis RD, who has celiac disease and works out of the celiac center in Boston with some of the top celiac experts.  She said Antibodies testing is the only non-evasive tool in the toolbox for monitoring progress, so it is better than nothing.  However, they are finding that it is not that accurate.  Here I was, beating myself up thinking I was either a super sensitive celiac or had non-responsive (due to dietary mis-haps) or refractory celiac disease.  My issues after months of carefully avoiding gluten were not due to celiac disease at all (at least the last six months prior to my endoscopy).  I did not eat out for a year.  Now, was it the Fasano diet?  Well, I went off it during the holidays.  I did not want to impact my endoscopy test results.  I just stuck to a normal gluten free diet without consuming too many sweets for a solid three weeks.  

I am glad I had my endoscopy.  It put my mind at ease and my GI knows that I was not cheating on my diet (not that he doubted me).  I can relax now!  I am doing a great job!  

Healed.  Your child might be healed.  Why the increase in antibodies?  I will let you know when the experts figure it out (maybe never since there is little funding and little goes to aftercare).  

[CeliacMommaX2]

I believe she's been tested for other AI diseases (it took 2 years to get her to "negative").  2 GI docs have said the DGP is unnecessary and she's never had one (only EMA and TTG). 

It would be nice to hear she is "healed" by checking with an endoscopy.

Thanks for your insight!

[Gemini]

Those 2 GI docs are wrong when they say the DGP is unnecessary.  That is the test that shows gluten ingestion from the diet.  However, you would have had to have them done at diagnosis for comparison to newer results, to be more relevant.  It could still be done because your daughter was serio-positive on the testing she did have done, which is not the case for many people.  I am not sure why they even have a complete Celiac panel when many doctors refuse to run the whole thing.  All tests on the panel give valuable information for a more complete picture, in those who actually trip the tests.

The blood tests have been incredibly useful for me in tracking my recovery.  I think they are very accurate and highly useful (at least for me) but that will only happen with serio-positive people. I did not have any funky Celiac blood work, once I had recovered. Antibodies have remained very low, with no spikes.  I am sure your daughter will be fine, as long as she seems to be recovering and her symptoms have gone away.  Good luck to you!

[Posterboy]

2 hours ago, CeliacMommaX2 said:

My 7 year old just had her TTG checked again (we were hoping to try gluten-free oats again for her).  It was 55!  (Up from 21 in October).  She was diagnosed 3 years ago and we've had trouble getting her TTG down.  (only got to 14, which <15 was considered negative).  We are super strict, gluten free household, homeschoolers and never eat out.  I'm trying to figure out why her TTG is 55 now!  She did have a stomach bug 10 days prior to her lab check (the whole family had it, so it wasn't gluten!).  Could that have elevated her labs?  Her GI doc wants to repeat her EGD now... I hate to put her through that again- anyone else have thoughts on if that's a good idea?

I'm just at a loss and don't know which way to go now.  Any thoughts are appreciated!

CeliacMommaX2,

It can happen here is a study on it.

Open Original Shared Link

I hope this is is helpful.

quoting from the discussion (heart) of any good research.

"This is the first study where anti-tTG have been shown to be produced temporarily during an infectious disease, independently of coeliac disease. Acute viral infections in children and adults have long been suggested to induce an autoimmune response, including generation of autoantibodies in which their titres are low and the autoimmune course transient [Open Original Shared Link].

In our study, more than half the children who tested positive to anti-tTG temporarily presented clinical and serological evidence of EBV infection. This supports the hypothesis that EBV contributes to antibody-mediated autoimmunity. Recent studies suggest that EBV latent membrane proteins might contribute directly to the development of autoimmunity [Open Original Shared Link] by inducing the expansion and survival of autoreactive B cells with the production of autoantibodies. This accounts for the transient appearance of autoantibodies during mononucleosis. In our cases the anti-tTG disappeared, together with the anti-EBV antibodies, along with the children's clinical improvement.

These findings indicate that anti-tTG should no longer be seen as a province of celiac disease, but might represent an immunological phenomenon depending on yet-to-be identified triggers (overexpression of the autoantigen, viral infection). Thus, autoantigenic challenges caused by infectious agents and/or inflammatory reactions during the lifetime could be responsible for the age-dependent increase of anti-tTG in the general population, as we observed among eight different healthy age groups [Open Original Shared Link]."

the good news is this is considered only a temporary/transient spike and their research showed normal anti-tTG levels at 12 months.

quoting their results.

"After 12 months on a gluten-free diet the coeliac patient's anaemia improved (Hb 13 g/100 ml, 23 ng/ml), his anti-tTG concentration returned to normal levels, and he tested negative for anti-endomysium antibodies (AEA)"

I have had the same thing happen for liver enzymes and while not common is a known cause of fasle positive Hep B results in blood exams.

My latter test's were normal for elevate liver enzymes due to a virus.

Again I hope this is helpful.

Posterboy by the grace of God,

 

 

 

[cyclinglady]

@Posterboy — 

Knitty Kitty found the same study.  Good work!  We knew that other Autoimmune issues could raise  a TTG result.  It appears that an infectious disease can too!  

@CeliacMommaX2 — While it would be nice to see if she is healed, with this information, you might consider waiting another six months and retesting especially since she has no symptoms or go forward with the endoscopy.  At least now you have some data that might make your decision easier!  

[Ranchers Wife]

Do you have any animals?

My husband did not improve on a gluten free diet... until we figured out that he was breathing barley and rye dust, LOTS of it, when he fed the cattle.

He also reacts when we put out (wheat) straw bedding, we switched to pine shavings.

If your daughter feeds chickens, horses, cattle, sheep, goats...or anything that might eat wheat, barley or rye she could be inhaling and thus ingesting enough gluten to cause an autoimmune response.

We even have gluten free dog food. That came about before the Celiac, though, because the dog wheezes when he ingests grains. But we don't have to worry about cross contamination via doggy kisses, anyway!