Positive ttg-IgA, negative CRG

[sg100]

Hi. I’m a 23 y/o male and I’ve had many symptoms of celiac for the last few months. I had a celiac blood test and my ttg-IgA came back positive at 58.9 (range 0-14.0) but my CRG was normal and at the lower end of the range. I’ve been fixating on this and as I’ve been experiencing really bad health anxiety I’ve kind of been hoping that celiac was the root of my symptoms in order to rule out more sinister things. Of course I won’t be able to be diagnosed by someone on here, but I was wondering if others had a normal CRG result whilst experiencing symptoms around their time of diagnosis. Thanks.

[trents]

CRG? Do you mean CRP?

[sg100]

Yes - sorry, CRP!

[trents]

CRP (C-Reactive Protein) is an inflammatory marker that can be used to detect some kinds of inflammation/injury in the body but it is not one that is used for the inflammation of the small bowel lining found in celiac disease.  CRP is not an appropriate lab test for diagnosing celiac disease whereas the tTG-IGA is and yours is high. What are your real-life symptoms?

Your next diagnostic step would be an endoscopy with biopsy of the small bowel lining to check for damage. Don't begin a gluten free diet if your physician wants to do this next stage of testing.

Edited February 12, 2022 by trents

[sg100]

I see, good to know, thanks! I’ve had a quite wide range of symptoms. I’ve had stomach discomfort, with bloating especially after eating, symptoms of indigestion such as gas and discomfort under my ribs (again, usually after eating). I’ve also had diarrhoea, and more recently what seems to be steatorrhea (which has recently been occurring after breakfast which has been containing gluten). I’ve had some weight loss, as well as a reduced appetite. Having had a lot of classic celiac symptoms I was sure that it was confirmed by the ttg-IgA result but then became confused by the lack of a high CRP result, but I see what you mean about that test not being such an appropriate test for celiac disease. Thanks

[sg100]

  On 2/12/2022 at 3:19 PM, sg100 said:

I see, good to know, thanks! I’ve had a quite wide range of symptoms. I’ve had stomach discomfort, with bloating especially after eating, symptoms of indigestion such as gas and discomfort under my ribs (again, usually after eating). I’ve also had diarrhoea, and more recently what seems to be steatorrhea (which has recently been occurring after breakfast which has been containing gluten). I’ve had some weight loss, as well as a reduced appetite. Having had a lot of classic celiac symptoms I was sure that it was confirmed by the ttg-IgA result but then became confused by the lack of a high CRP result, but I see what you mean about that test not being such an appropriate test for celiac disease. Thanks

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Oh, and I had really bad fatigue until I was prescribed high strength Vitamin D supplements after a blood test I took in January showed I was Vitamin D deficient.

[trents]

Your doctor may have ordered the CRP to check for other inflammatory processes but I have not ever heard of it being used for celiac disease diagnosis.

Many of the symptoms you describe are very common to celiac disease as is the low Vitamin D levels. Nutrient malabsorbtion is caused by the damage to the small bowel villi. The villi are the nutrient absorbing organ system of the body.

What do you mean when you say your stool contains gluten? Steatorrhea is about the visible presence of fats and oils in the stool. It causes "floaty" stools. In people with celiac disease, this is related to malabsorption issues.

You should also consider a high potency B-complex vitamin as the B's (along with D) are commonly deficient in celiac disease. Costco's Nature Made B-complex is a good gluten free B-complex choice.

Is your doctor planning an endoscopy/biopsy or has he/she definitely concluded you have celiac disease?

[sg100]

Yeah, the doctor did say that’s what it was for. Knowing that celiac causes inflammation in the SI, I thought the CRP would pick up on that (even though it isn’t used to specifically determine celiac disease) so with the CRP being in range I was wondering if that ruled out celiac, despite the high ttg-IgA number but I understand from what you say that it doesn’t. 

When talking about my stool I meant that I was having fatty stools after eating food containing gluten, rather than my stools having gluten - simple misunderstanding!

It’s not been outright confirmed as celiac, my blood test results have a note saying that they’re doing confirmatory testing for antiendomysial antibodies, but I would imagine that I will have a biopsy arranged by the doctor. 

I know that the only way of getting a firm diagnosis is through my test results, but like I mentioned the CRP result has just caused such confusion!

[trents]

CRP is kind of a Swiss army knife for detecting inflammation but I have never heard of it being used for diagnostic purposes with regard to celiac disease. It is often used to detect rheumatoid processes.

It's really important to keep eating normal amounts of gluten until all testing is done, including a biopsy should that be ordered. A lot of doctors neglect to tell their patients that and the result is that testing is invalidated or at least compromised.

[sg100]

I see - so although the CRP is negative it definitely wouldn’t rule out celiac, especially given my antibody test? Sorry I know I’m repeating myself, you can probably tell that I am anxious about it!

[trents]

  On 2/12/2022 at 6:35 PM, sg100 said:

I see - so although the CRP is negative it definitely wouldn’t rule out celiac, especially given my antibody test? Sorry I know I’m repeating myself, you can probably tell that I am anxious about it!

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Yes, that's what I am saying. And it's okay to be anxious. A very normal response, especially when a myriad of other rather serious health conditions have not yet been ruled out. And I think people also dread the implications of finding out they have celiac disease, realizing that it will call for some serious life-style changes and will alter their social lives.

Edited February 12, 2022 by trents