Transient / Temporary Celiac

[Bluewonder]

So my blood work shows temporary celiac antibodies that clear over time (whilst remaining on normal gluten diet). 

I was wondering if this is normal and if anyone else here has experienced the same?  Now that the antibodies have returned, is there any further tests that i should consider? Based on the historical pattern 2015-2018, my gluten sensitivity looks to be temporary rather than a life long condition.

2015: Initial Diagnosis

Endomysial AB IGA: Positive

Gliadin IgG: Negative: 4.5 U/ml (Negative reference range <7)

Gliadin IgA:  Borderline/Equivocal:  8.8 U/ml (Negative reference range <7, Equivocal: 7 - 10)

t-Transglutaminase IgA:Positive: >128 U/ml (Normal reference range 0 - 10)

Reticulin IgA:  Positive

IGA: 3.35 g/L (Reference range 0.70-4.00)

 

2016: Improvement in Antibodies: whilst on a normal gluten diet

Endomysial AB IGA:  Positive

Gliadin IgG:  Negative: 5.0 U/ml (Negative reference range <7)

Gliadin IgA:  Negative:  3.7 U/ml (Negative reference range <7)

t-Transglutaminase IgA: Positive:  21 U/ml (Normal reference range 0 - 10)

Reticulin IgA: Negative

IGA: 2.89 g/L (Reference range 0.70-4.00)

 

Mid 2018: Complete Reversal of Antibodies - whilst on a normal gluten diet

Anti-Transglutaminase IgA: Negative:  6 U/ml (Normal reference range <7)

IGA: 328 (Reference range 68-514)

Anti – Deamidated Gliadin IGA DGP Negative

Anti Gliadin AGA IGA Negative

Anti Gliadin AGA IGG Negative

 

March 2021: Relapse

Anti-Transglutaminase IgA: Positive:  66.7 U/ml (Normal reference range <7)

 

 

[trents]

First I have ever heard of this phenomenon.

If I were you, I would seek an endoscopy/biopsy of the small bowel in order to check for damage to the small bowel villi. During the periods where your antibodies are positive, I would think that would be indication that inflammation and damage are occurring. That in itself should give you pause as to whether or not is is wise to continue consuming gluten. And one thing you made no mention of and that is symptoms. Are there times when you are experiencing the symptoms of celiac disease? What leads you to get the testing done repeatedly?

May we ask what is your age group?

 

[Scott Adams]

You are interpreting the blood test results incorrectly. Where you list results as “a complete reversal,” you were actually just under the borderline, so you are still high, but just not high enough to call it “celiac disease.” Clearly your body has been having an autoimmune reaction to gluten in each of these blood tests, and you probably should’ve had a biopsy after the very first one. This is exactly why I think the cut off lines in these tests are somewhat arbitrary. Normal people don’t score this high:

Anti-Transglutaminase IgA: Negative:  6 U/ml (Normal reference range <7)

[Bluewonder]

1 hour ago, trents said:

First I have ever heard of this phenomenon.

If I were you, I would seek an endoscopy/biopsy of the small bowel in order to check for damage to the small bowel villi. During the periods where your antibodies are positive, I would think that would be indication that inflammation and damage are occurring. That in itself should give you pause as to whether or not is is wise to continue consuming gluten. And one thing you made no mention of and that is symptoms. Are there times when you are experiencing the symptoms of celiac disease? What leads you to get the testing done repeatedly?

May we ask what is your age group?

 

Im in my mid 30's. 

The gastro did do a biopsy in 2016 and found partial villous atrophy with increased IELS (60).  But further testing of the biopsy showed a parasitic infection, which is likely to have caused the atrophy.

Before i could do a repeat biopsy after this infection had cleared up, the antibodies normalised. 

The current highly positive ttg result is likely to indicate damage/inflammation, but not sure if this is likely to be due to a reoccurrence of the infection or if i was celiac all along. 

No symptoms that i can think of. Initially celiac testing was done because of low iron levels, but these are now normal. I do regular blood tests for HbA1c (recently diagnosed T2 diabities), so i asked the GP to include ttg.   

 

 

[Bluewonder]

59 minutes ago, Scott Adams said:

You are interpreting the blood test results incorrectly. Where you list results as “a complete reversal,” you were actually just under the borderline, so you are still high, but just not high enough to call it “celiac disease.” Clearly your body has been having an autoimmune reaction to gluten in each of these blood tests, and you probably should’ve had a biopsy after the very first one. This is exactly why I think the cut off lines in these tests are somewhat arbitrary. Normal people don’t score this high:

Anti-Transglutaminase IgA: Negative:  6 U/ml (Normal reference range <7)

Not quoted in the figures above, but another ttg test in late 2015 showed that the TTG levels skyrocketed to >150 U/ML (Normal <7). So a decrease to 6 seemed very significant. 

Also in 2018, the Anti Deamidated Gliadin was only 2.4 (normal <6.9 U/ml) so well below the cut-off.

 

 

 

[trents]

Then I would certainly get tested to see if the parasitic infection has returned. We do know that certain non celiac medical conditions, some medications, and even senitivities/allergies to some non-gluten containing foods can mimic celiac disease and give positive antibody results.

[knitty kitty]

Welcome to the forum, @Bluewonder,

If your parasitic infection was treated with some sort of antibiotic, your antibodies would have gone down due to the anti-inflammatory and immunosuppressive effects of the antibiotic.  

Iron deficiency anemia can also cause reduction in white blood cells (antibodies).  Now that your iron deficiency is corrected, maybe you're making more antibodies again.

Iron deficiency is frequently the only presenting symptom of Celiac.  Type Two Diabetes is often associated with Celiac Disease, as are several other autoimmune diseases.

Seems like you keep rolling the dice with the antibody tests.  Might be time to accept a Celiac diagnosis and adopt a gluten free diet.  What piece of information would convince you?  

I finally got a genetic test.  I have two genes for Celiac Disease.  Prescription medications had made my antibody tests inaccurate, so I was misdiagnosed for years. 

Discuss with your doctor what he can do to help you resolve your diagnosis dilemma. 

Best wishes.

 

 

 

2 hours ago, Bluewonder said:

Im in my mid 30's. 

The gastro did do a biopsy in 2016 and found partial villous atrophy with increased IELS (60).  But further testing of the biopsy showed a parasitic infection, which is likely to have caused the atrophy.

Before i could do a repeat biopsy after this infection had cleared up, the antibodies normalised. 

The current highly positive ttg result is likely to indicate damage/inflammation, but not sure if this is likely to be due to a reoccurrence of the infection or if i was celiac all along. 

No symptoms that i can think of. Initially celiac testing was done because of low iron levels, but these are now normal. I do regular blood tests for HbA1c (recently diagnosed T2 diabities), so i asked the GP to include ttg.   

 

 

 

[trents]

knitty kitty, I have not heard before that antibiotics have immunospressive and anti-inflammatory effects.

[Scott Adams]

“the TTG levels skyrocketed to >150 U/ML (Normal <7).”

In Europe the current protocol is to diagnose celiac disease if you TTG are 10x above the high marker—no biopsy needed. Also TTG is very specific to gluten, and I’m not aware of any parasitic infections that raise TTG levels.

[knitty kitty]

14 hours ago, trents said:

knitty kitty, I have not heard before that antibiotics have immunospressive and anti-inflammatory effects.

http://www.google.com/search?q=are+antibiotics+anti-inflammatory+nih&oq=are+antibiotics+anti-inflammatory+nih&aqs=heirloom-srp..

Apparently so.

[trents]

5 hours ago, knitty kitty said:

http://www.google.com/search?q=are+antibiotics+anti-inflammatory+nih&oq=are+antibiotics+anti-inflammatory+nih&aqs=heirloom-srp..

Apparently so.

Good to know. Thank you.

This is very interesting. Overuse/misuse of antibiotics has been implicated in the development of celiac disease because of the negative effect it has on gut microbiota. But may antibiotics also be a treatment for it? And maybe the use of antibiotics in meat and milk production is not such a bad thing for humans if residues help suppress inflammatory processes? This topic has long fingers and needs more exploration.

Edited March 21, 2021 by trents

[docaz]

This type of situation is actually documented. Here is one paper that describes spontaneous normalization of the blood tests in children with diabetes. https://care.diabetesjournals.org/content/38/11/e188

The previous head of the UofC celiac center mentioned to me that there are rare situations in which celiac patients who ate gluten went into a temporary remission but in all cases that he is aware of, sooner or later the numbers went back up. There are even cases of asymptomatic celiac patients in which the Marsh classification of the intestinal damage improved. Dr. Marsh himself mentioned that at a symposium. If I remember correctly there is a case in which the numbers stayed normal for over 10 years but then they did go back up again.

I had also an informal discussion with the head of the department at Leiden University, and he mentioned that as we all know, not every person who has the genetic predisposition will develop celiac disease but something triggers it. At this time it is unknown what the trigger is. He hypothesized that if someone could possibly keep a gluten-free diet with the numbers within normal limits for a long period of time (he estimated about 15 years), there is a possibility that that person reverses back to just being predisposed. This is obviously not proven and because of the long time-span it is very difficult to investigate and chances are that the answer will only be known many years from now.

The important message is that even is someone is asymptomatic , it is worth to be careful not only for the obvious reasons to mitigate associated diseases but also to keep the numbers normal for many years in case that the hypothesis turns out to be accurate. 

[Bluewonder]

So the doctor did a stool test, they found that the parasitic infection is back. So they are going to put me on antibiotics again.

This could explain why the ttg antibodies re-appeared. 

 

[trents]

Yes, it would seem.

[Scott Adams]

1 hour ago, Bluewonder said:

So the doctor did a stool test, they found that the parasitic infection is back. So they are going to put me on antibiotics again.

This could explain why the ttg antibodies re-appeared. 

 

Can you share what parasitic infection they found? I'm still not sure how a parasitic infection would increase your TTG score.

[Bluewonder]

26 minutes ago, Scott Adams said:

Can you share what parasitic infection they found? I'm still not sure how a parasitic infection would increase your TTG score.

It was Giardia. There is a body of research that suggests this infection can spike TTG and even turn EMA positive. This is often on a temporary basis but for some it can activate celiac.

For me its been a challenge to differentiate giardia from celiac.

https://pubmed.ncbi.nlm.nih.gov/29911457/

 

 

[Scott Adams]

That is interesting, and I will try to get a copy of this study and summarize it. Let us know how things turn out.

[Chellalee76]

On 3/26/2021 at 4:22 PM, Scott Adams said:

That is interesting, and I will try to get a copy of this study and summarize it. Let us know how things turn out.

Ever get around to summarizing this?  I am beginning to think what I thought was celiac is actually giardiasis.  Scouring for information.

[Scott Adams]

Unfortunately we could not get a copy of the full study.

[knitty kitty]

@Chellalee76,

There's some evidence that anti-tTg IgA can be produced during infection with infectious agents, but if the infecting agent is treated the antibodies go away.  

https://pubmed.ncbi.nlm.nih.gov/33895735/

And...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810390/

 

Giardiasis is known to interfere with the production of ATP from Thiamine Vitamin B 1.  

If your giardiasis has been treated, you may still be suffering from Thiamine deficiency as many of the drugs used to treat Giardia also block thiamine from being properly utilized.  

Thiamine deficiency can present with symptoms similar to untreated Celiac.  Gastrointestinal Beriberi symptoms include nausea, vomiting, cramping, diarrhea, etc.  

The World Health Organization (WHO) says that if a thiamine deficiency is suspected, administration of a minimum of 500 to 1500 mg/day of Thiamine Hydrochloride should be given for several days.  If improvement is seen, Thiamine should be taken for several months, dosage can be adjusted.

Hope this helps!

Edited May 12, 2023 by knitty kitty
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