GLIADIN, DEAMINATED, IGG Elevated

[creativemuse]

Ah the joys of electronic medical records. I went to the doc this week for GI upset and she included a GLIADIN, DEAMINATED, IGA & IGG, SERUM test as part of the workup. The results were released automatically to MyChart so I was able to access them online without talking to the doctor, but she added a note (I assume to the nurse) "Let her know that her celiac sprue test (for gluten intolerability) was positive. There are false positives however so the confirmatory test is an egd with biopsy of the small intestine so I will get that scheduled for her. Don't change her diet before that or we won't get an accurate test."

The results were: 

Gliadin IgG

29 Reference range: <20

Gliadin IgA

14 The results should be interpreted in relation with the IgA levels. If patient is found to have undetectable IgA levels, future serologic testing with only IgG-based assays for Gliadin (deamidated) and Tissue Transglutaminase is recommended. Reference range: <20

As far as I can tell, no other celiac specific tests were run, but my SED rate was slightly elevated.

19 mm/hr

Standard 0 - 15 mm/hr

Of course it is a holiday weekend in the US, so I can't call to schedule the endoscopy until Tuesday. Dr. Google is full of all kinds of confusing information. I know that nobody can diagnose me over the internet, but I think what I am reading is telling me that biopsy is definitely indicated. I know that I cannot change anything until after the test to avoid a false negative, but I'm trying to get an idea of the odds. Some things I read say 90%+ chance of celiac with this result. Is that correct or am I mixing up which test is which?

[GFinDC]

Hi,

You are right the gliaden IgG is an antibody test for celiac disease.  You are positive on the test so that means your immune system is reacting to the presence of gluten in your diet.  The endoscopy is fairly simple and easy.  They put an thin tube down the throat and take a look around.  While they are touring the neighborhood they take 4 to 6 small samples of tissue for microscopic examination.  If those biopsy samples show the typical damage associated with celiac you get the diagnosis of celiac disease.  Endoscopy sometimes take few months to happen.

Welcome to the forum!

[creativemuse]

Update: I had the endoscopy this morning. The GI asked if I had a positive celiac panel and I mentioned that only the Deamidated IGA/IGG had been run and he got positively cranky. He went back and looked and said that it was only mildly elevated and acted irritated that I was even having a biopsy at this point. He did order the EMA, IGA and TTG blood tests, so I went over and did that blood draw after the endoscopy. He told me not to change my diet until those blood tests and the biopsy results come back because he was doubtful it was celiac. He also commented on the fact that I am not anemic. I understand not changing anything until after the testing, but there isn't anything left to test at this point, right? I'm not going to hurt anything if I go gluten free now? I just want to feel better!

Edited June 5, 2018 by creativemuse

[cyclinglady]

Listen to the GI.  Do not go gluten free yet.  Why?  What if they mess up on the biopsies?  You should wait until you have the blood tests back and the pathologist’s report in hand.  Believe me, Mistakes can be made (losing things, etc.).  Something caused that elevation.  If it turns out not to be gluten, then what?  

[creativemuse]

The final results are very mixed. TTG 39 (ref >20), EMA Negative, DGP IgG 29 (ref >20) and the note from the doctor says "small bowel biopsy reveals inflammation but no evidence of celiac sprue. However TTG antibody is mildly elevated which is specific for celiac sprue. It is possible she has early celiac sprue without damaging the small bowel." He ordered the gene test as well. I uploaded my Ancestry DNA test to Promethease and it indicates that I have at least one gene associated with celiac, but it can't be taken as medical advice, so I am waiting for official results on the lab test. I am waiting for the pathology report to find out how many samples he took, etc. 

How hung up on the label of celiac do I need to be? Should my parents and siblings and children be screened based on these results? I have stopped eating gluten as of yesterday and I am just getting my feet wet learning about cross contamination, etc. Do I just assume zero tolerance and behave as if it is 100% confirmed? I am already dreading our family vacation next month sharing a kitchen where literally 25+ family members will be in and out, cooking, grabbing snacks, etc.

 

[Ennis-TX]

1 hour ago, creativemuse said:

The final results are very mixed. TTG 39 (ref >20), EMA Negative, DGP IgG 29 (ref >20) and the note from the doctor says "small bowel biopsy reveals inflammation but no evidence of celiac sprue. However TTG antibody is mildly elevated which is specific for celiac sprue. It is possible she has early celiac sprue without damaging the small bowel." He ordered the gene test as well. I uploaded my Ancestry DNA test to Promethease and it indicates that I have at least one gene associated with celiac, but it can't be taken as medical advice, so I am waiting for official results on the lab test. I am waiting for the pathology report to find out how many samples he took, etc. 

How hung up on the label of celiac do I need to be? Should my parents and siblings and children be screened based on these results? I have stopped eating gluten as of yesterday and I am just getting my feet wet learning about cross contamination, etc. Do I just assume zero tolerance and behave as if it is 100% confirmed? I am already dreading our family vacation next month sharing a kitchen where literally 25+ family members will be in and out, cooking, grabbing snacks, etc.

 

Just bring your own food, or your own microwave cooking kit. I keep a set of Nordic ware microwave omelette makers, everyday bowl, grill plates with splatter covers and steamers for traveling, they also rice cookers etcs. Put down a paper towel, mix up your meals and cook in the microwave from whole foods...and bring safe snacks, bars, MREs you can have. Butcher paper for your own easy safe prep areas and eating mat that you just throw away with the mess for easy clean up.

 

[cyclinglady]

Was the doctor’s diagnosis based on just the endoscopy?  Mine was normal, yet the pathologist’s report revealed patches of moderate to severe damage.  Plus, you probably know that the small intestine is the size of a tennis court and it is easy to miss damaged areas.  

Do not fret about the vacation.  I go to a family lake house that is packed with gluten eaters.  I bought a bin and keep in our room (adults get rooms and beds!).   We use lots of paper plates and cups and we run through items in the dishwasher.  I have a cheap non-stick frying pan and spatula, parchment paper, foil (to wrap items on the grille, etc).  You can use disposable items form the dollar store.  I keep some food in my room.  For example. I will eat chips, but once opened, I do not touch them.  Too many kids reaching in and forget about gluten, but dirty hands!  Of course, the adults do not condone this, but I am sure it happens (I was a kid once).   We use squeeze bottles for condiments.  You will figure it all out.