Blood test interpretation question

[Timloveswheat]

Hi All,

I recently went to a new doctor doctor as i had a stomach ache for 7-8 days. She tested me for a few things, Celiac being one of them. My previous bloods 4 months ago had indicated Anemia Ferritin - 28L & 22L (30-400). The recent Ferritin test was higher at 51. 

My Celiac tests show a low positive for one antibody 

Deamidated Gliadin IgA - H17 U/ml <15

Deamidated Gliadin IgG 2 <15

Tissue Transglutaminase IgA <1 

Tissue Transglutaminase IgG <1 

I had to see another doctor for results and he didn't really seem to know about this. He suggested i should/could try Gluten free and that i could see a Gastro specialist. I asked for the referral. 

After getting home and reading, my basic interpretation is that its fairly unlikely i've got celiac disease? One Australian article i read said that the low positive i have is typically a false negative if the other ones are low. 

I'll be honest - as nuts as it is was kind of hoping i might have Celiac. I've had very bad anxiety & some depression which has gotten better. I get periodic diahorrea (maybe every 3-4 months and occasional consipation which i put down to stress. Recently ive been very fatigued and have had heavy / tired legs despite feeling happier / less anxious lately. Only in the last maybe 6 months have my fingers started aching (just a few of them). I was tested for Rheumatoid arthritis but was negative for that. The worst thing is the bone tiredness. 

Oh yeah, i eat a bucket of wheat. Subway 1-2x per week, occasional chips, sauces, sometimes a donut etc. So i cant be that badly reacting to it right? 

Sooo, just a second opinion? 

a) Don't worry

b) try gluten free

c) talk to the specialist? 

Cheers

[Timloveswheat]

Hi again, 

Just wanted to post the article i was referring to. Its pretty clear that its unlikely i have Celiac. 

https://www.dhm.com.au/media/Multisite8418/dhm_information-for-clinicians_coeliac-disease_201501.pdf

"Deamidated IgA and IgG gliadin antibody assays IgA and IgG antibodies can be detected by ELISA tests and now with an ALBIA method. The results are reported in units over a 'cut-off'. The numbers or values of these results exhibit a good dynamic range of values. They mainly have utility for monitoring compliance with gluten-free diets in patients. Usually IgA gliadin antibodies are negative after 6-9 months of a gluten-free diet (normal <15 U/mL). The IgG gliadin antibodies usually become negative 12-18 months after introduction of a gluten-free diet (normal <15 U/mL). This assay is very sensitive but less specific for identification of patients with coeliac disease. The results are almost invariably strongly positive in most patients with coeliac disease not on a gluten-free diet and low-level positives do not necessarily have clinical significance. An important advance has been made in deamidation of the gliadin antigen. This has reduced the number of false positives in IgG and now IgA gliadin antibody assays. Isolated gliadin IgA antibodies are usually false positives (when other markers are negative)."

Looks like it came from this study from anyone interested. 

https://celiacdiseasecenter.columbia.edu/wp-content/uploads/2018/12/Diagnostic-Yield-of-Isolated-Deamidated-Gliadin-Peptide-Antibody-Elevation-for-Celiac-Disease.pdf

So according to that it looks like id have a 3.7% of Celiac. Could this indicate a bit of an intolerance, early celiac or maybe just an aberration? 

Edited February 4, 2020 by Timloveswheat

[kareng]

Low positives can be from other things.  And having a stomach ache for a week could be lots of things, even just the after effects of a light case of food poisoning or a stomach virus.  

[Fenrir]

Stomach ache for a week is pretty hard to pinpoint anything. Most celiacs are having issues for months and years before they get diagnosed. Based on your labs it's pretty unlikely, but not impossible that you have celiac disease. 

A week's worth of tummy trouble could be simply eating something that doesn't agree with you, constipation, lack of exercise, food poisoning, stomach bug.....any number of things. 

[cyclinglady]

I do think you should assume anything.  While you might not have celiac disease, you might. 

Everything Karen and Fenrir has said could be true.  

I had iron-deficiency anemia on and off my life.  It was always blamed on my being a woman and due to a genetic anemia called Thalassemia.  I always bounced back after a round of iron supplements.  I also had GI issues that waxed and waned throughout my life.  Nothing consistent.  

My diagnosis was caught when I saw a GI for a colonoscopy because I had hit 50 and needed a cancer screening.  Based on my life long periods of anemia, he ordered a full celiac panel.  I only had one positive — the DGP IgA.  So, he also ordered an endoscopy.  It revealed moderate to severe damage.  I was shocked!  I had no GI issues the year leading up to my endoscopy!  Believe me I have searched every article in an attempt to reconcile only having a positive DGP IgA.  In fact, I have had the panel repeated many times.

What I have learned is that sometimes it helps to have several people who wear white coats help diagnose you and not to rely just on Dr. Google (though Dr. Google has great value).  

If you are going to pursue a celiac disease diagnosis, be sure you stay on a full daily gluten diet.  ALL celiac disease testing requires you to be on a gluten diet .  Otherwise you could be stuck in diagnostic limbo land.  

We do not know your complete story.  Maybe you have left a few things out.  Like I forgot to mention that I have autoimmune thyroiditis, another risk factor of celiac disease and that my family is riddled with autoimmune (RA, Graves, lupus, etc.)

Your result is borderline.  Best see someone who is celiac-savvy and that is usually not your average PCP/GP/Internist.  

Edited February 4, 2020 by cyclinglady

[Fenrir]

Yeah, with the one test being slightly elevated celiac isn't ruled out yet. It would probably be worth while to have an EGD done if it's something you can afford to do. 

[Timloveswheat]

Thanks for all of your replies. Re the stomach ache I agree, although i actually had a similar thing for about 5 days a month ago and yesterday i had it again. That being said I think stress compounds it so i'm willing to accept that part might be psychological. 

What concerns me a little is that i've had anemia. Considering i eat a lot of meat that is something that warrants investigation i think. 

  On 2/4/2020 at 4:14 PM, cyclinglady said:

My diagnosis was caught when I saw a GI for a colonoscopy because I had hit 50 and needed a cancer screening.  Based on my life long periods of anemia, he ordered a full celiac panel.  I only had one positive — the DGP IgA.  So, he also ordered an endoscopy.  It revealed moderate to severe damage.  I was shocked!  I had no GI issues the year leading up to my endoscopy!  Believe me I have searched every article in an attempt to reconcile only having a positive DGP IgA.  In fact, I have had the panel repeated many times.

What I have learned is that sometimes it helps to have several people who wear white coats help diagnose you and not to rely just on Dr. Google (though Dr. Google has great value). 

Expand Quote  

That's really interesting - you're absolutely right i'm not ruling it out at all. Was your reading fairly high? Mine is a low positive i guess. The only other things i didn't mention is i do have poor sleep (which has myriad causes), and the only relevant thing in my family is a few people with thyroid problems i guess. 

I think i'll monitor for a couple of weeks but i might see the specialist because there are some other possible causes i could also discuss. The one thing i am pretty sure is that there is something wrong. I feel exhausted so hopefully some answers come soon! 

Take care. 

Edited February 5, 2020 by Timloveswheat

[cyclinglady]

I would see the specialist.  A guy being anemic is not good.  Every month a woman’s iron levels drop (not necessarily dramatically) due to menstruation, but the body amazingly recovers fast.   Anemia can cause heart failure.  Best to rule out cancer even though it is likely to be celiac disease over cancer.  

Bone issues?  Two months after my diagnosis, I fractured my back doing nothing.  Turns out I have osteoporosis as a result of undiagnosed celiac disease.  Looking back, It hurt to lay on my side contributing to sleep issues.   My hips and ribs were affected or at least were symptomatic.  All that resolved once I was able to absorb nutrients on a gluten-free diet.  

While my DGP IgA result was much higher than yours,  that does not mean much.  It was actually higher when I had a repeat endoscopy five years later and at that time I had a healed gut.  Remember, antibodies testing is just a tool.  Some celiacs (or anyone with autoimmune) could be seronegative on antibodies tests.   That is why doctors in white coats are helpful.  They often have to rely on training and clinical experience.  If they are good, they are always researching.  

[Fenrir]

Males with anemia is unusual if something isn't wrong. 

I was anemic when diagnosed with celiac (and I'm male, just in case that wasn't clear). While it may be unlikely you have celiacm, you do have a positive aby test and some symptoms that are common to celiac disease. I would ask your Dr. about the possibility of doing an EGD to check for celiac and/or an stomach ulcer. Both of these can cause stomach pain and anemia in men.