IGA vs. IGG. Questions...please help! :)

[kaelynrose89]

A little background...I'm a 28 year old female, and have always had stomach issues (bloating/constipation/sharp pains). Always felt like I had just eaten a huge cheeseburger, xl fry and a shake, when I just ate a bowl of cereal. My mom recently informed me that when I was 12 months old I was diagnosed celiac, but I outgrew it. Last week, I went in to ask my doctor to run a test to see if that's the reason I've been having issues all these years. Results were that my IGA was <1 (would have been > or = 4 to detect an antibody), but my IGG was high at 22 (antibody detected at > or = 6).

She noted that I have increased levels of immune transglutaminase without acute celiac disease and to follow a gluten free diet. I'm wondering if I should just leave it alone or push for the biopsy just to be clear. Any suggestions? I'm conflicted because my doctor doesn't seem concerned, but my husband works at a hospital and asked some of the doctors there and they seem to think there's a good possibility it could be Celiac.

[GFinDC]

Hi,

You only have to be positive on 1 antibody test to have celiac disease.  One kind of immune cell attacking your gut can do plenty of damage.  They are powerful little buggers!

People don't get over celiac disease, although that was thought to be true in the past.  What does happen is sometimes a person's immune system will take a break from attacking for an while.  That doesn't last forever though and at some point the immune attack will resume.  The same thing happens in other AI diseases at times.  That resumption of symptoms is sometimes called a "flare-up" in other conditions.

If you are unsure of your diagnosis, then get the endoscopy done.  But don't stop eating gluten until the endoscopy is complete.  The GI will generally take from 4 to 6 biopsy samples of the small intestine for microscopic examination.

There is some info in the Newbie 101 thread posted in the Coping With section that may help.

[kaelynrose89]

7 minutes ago, GFinDC said:

Hi,

You only have to be positive on 1 antibody test to have celiac disease.  One kind of immune cell attacking your gut can do plenty of damage.  They are powerful little buggers!

People don't get over celiac disease, although that was thought to be true in the past.  What does happen is sometimes a person's immune system will take a break from attacking for an while.  That doesn't last forever though and at some point the immune attack will resume.  The same thing happens in other AI diseases at times.  That resumption of symptoms is sometimes called a "flare-up" in other conditions.

If you are unsure of your diagnosis, then get the endoscopy done.  But don't stop eating gluten until the endoscopy is complete.  The GI will generally take from 4 to 6 biopsy samples of the small intestine for microscopic examination.

There is some info in the Newbie 101 thread posted in the Coping With section that may help.

I really appreciate your feedback! I feel like I have to push my doctor at times to thoroughly examine my concerns, so I'll have to fight for that referral to a GI doc, just for my own peace of mind. I go back and forth wondering if it even matters to get a final diagnosis since the only way to keep it under control is with a gluten free diet, which I think I'll try to follow anyways. It's only been 3 days since I've officially eliminated gluten from my diet, so I need to figure out what I'm going to do.... =/ Thank you so much for taking the time to respond!

[cyclinglady]

I just wanted to add that when I was diagnosed, I only suffered with anemia that was always blamed on my being a female.  Seriously.  It is amazing that I was able do triathalons and century rides.....I think it was due to true grit and the bodies ability to cope. 

If my doctor had not ordered the complete celiac panel, my diagnosis would have been missed.  It looks like you just got the screening TTG tests which catch most, but not all celiacs.  Often only a GI can order the complete panel depending on your provider.  Found that out when my family went in for testing (that would be Kaiser....).

Get to a GI!  Ask for the rest of the panel (DGP IgA/IgG and EMA).   I test positive to only the DGP IgA even in follow-up testing, yet I had severe damage.  

Finally, keep in mind that some 10% of celiacs are seronegative.  Proceeding to an endoscopy would be the next step.

What was your total IGA (Immunoglobulin A)?  Was that test given?  If you are IgA deficient, you will NOT get a valid response out of any of the IGA type tests (e.g. TTG IgA).  

[kaelynrose89]

19 hours ago, cyclinglady said:

I just wanted to add that when I was diagnosed, I only suffered with anemia that was always blamed on my being a female.  Seriously.  It is amazing that I was able do triathalons and century rides.....I think it was due to true grit and the bodies ability to cope. 

If my doctor had not ordered the complete celiac panel, my diagnosis would have been missed.  It looks like you just got the screening TTG tests which catch most, but not all celiacs.  Often only a GI can order the complete panel depending on your provider.  Found that out when my family went in for testing (that would be Kaiser....).

Get to a GI!  Ask for the rest of the panel (DGP IgA/IgG and EMA).   I test positive to only the DGP IgA even in follow-up testing, yet I had severe damage.  

Finally, keep in mind that some 10% of celiacs are seronegative.  Proceeding to an endoscopy would be the next step.

What was your total IGA (Immunoglobulin A)?  Was that test given?  If you are IgA deficient, you will NOT get a valid response out of any of the IGA type tests (e.g. TTG IgA).  

They tested "Tissue Transglutaminase AB, IGG", results were high at 22 U/mL

"Tissue Transglutaminase AB, IGA", results were <1 U/mL

Because my IgA test came back negative, she put in her notes that I do not have celiac, but told me to follow a gluten free diet. Everything I'm reading, and every health care professional my husband works with, seems to think there's a strong possibility that it could be celiac because my IGG levels were so high. Obviously my body is fighting SOMETHING off, and I just want a conclusive answer. Challenging finding that balance between being proactive about my health and having your doctor settle for inconclusive results.

[cyclinglady]

So, I am assuming Immunoglobulin A test was not given.  Your doctor can not say that the TTG test result (that was less than 1) is even accurate.  If you do not make IgA, then the IgA tests are invalid.  Again, your result is not standard, but that does not mean you can not have celiac disease.  I have never had a positive on either of the two tests that you were given.  Ever.  Taken repeatedly.  Yet, my biopsies revealed severe damage.  

Please consider another opinion from a celiac-savvy GI.  Your primary doc is way off in my non-medical opinion.  Sure you can go gluten free, but maintaining this diet for life can be very hard if you have any doubts.  

[frieze]

doc wrong, find new doc.  cycling and I may not be docs, but we do know our way around a blood test or two.  good luck.  and remember her "wrongness" if anyone asks for suggestions for a doc.

[KKJ]

When I was tested, my IGa came back very low, nearly nil. Turns out that I have the most common form of immune deficiency called an IGa deficiency. So, my doc ran other tests to confirm/rule out celiac as well astook a biopsy, and for sure, all results showed that I have celiac.

Many of us with IGa deficiency are asymptomatic and the thought among immunologists (at least mine)  is that those of us w/o symtpoms likely have IGg in the areas were there'd be IGa and it's taken over the role of the missing / low IGa.