Celiac?

[Scrapmanson]

Hey guys new here, I've flet horrible and can't seem to get any answers, just trying to see if this is possible celiac or something else. So this long road started about 7yrs ago my daughter got real sick and I started having burning stomach and lost some weight and such, so started going to Dr, for blood work and I got fobed off. Well since then I've had more issues and I'm still only diagnosed with gastritis and ibs. About 3 yrs agoI had CT scan all Clear, colonoscopy all clear, endoscopy with biospy showed mild chronic gastritis, blood work always good except slightly high mpv 11.7 with 11.6 as the standard. My symptoms include burning stomach, abdomen pain, back pain, bloating, tons of gas, white tongue, large sticky stool, floating stool, constipation, loose stool, I'm sure a few things I'm missing. Anyways had a celiac blood test done recently, and I'm scheduled for another endoscopy in 2 weeks. Here's my test results. I did go in today and ask for a total iga serum test, waiting on results. Thanks! 

Ttg iga neg .5<15

Ttg igg neg .8<15

Diam igg neg .4<15

Diam iga pos 22.5

[knitty kitty]

Welcome to the forum!

Have you been checked for Small Intestinal Bacterial Overgrowth?

SIBO can occur with or without Celiac Disease.  That white tongue might be thrush, Candida overgrowth.  

Do you have Diabetes?  Do you eat a diet high in carbohydrates? 

Hope we can help you find answers.

[Scrapmanson]

  On 6/27/2022 at 8:39 PM, knitty kitty said:

Welcome to the forum!

Have you been checked for Small Intestinal Bacterial Overgrowth?

SIBO can occur with or without Celiac Disease.  That white tongue might be thrush, Candida overgrowth.  

Do you have Diabetes?  Do you eat a diet high in carbohydrates? 

Hope we can help you find answers.

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Thank you, I have thought about sibo, haven't tested it because seems like it's more a functional Dr believe with alot of false results. Also not sure where I can get tested. My normal Dr said he didn't think my tongue was candida, it's like white with some red patches and kinda comes and goes depending how I'm feeling. I do not have diabetes. I would say I eat carbs.

[trents]

What about NCGS?

[Scrapmanson]

  On 6/27/2022 at 8:52 PM, trents said:

What about NCGS?

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That's kinda why I'm asking if my tests look like celiac or something else? 

[trents]

  On 6/27/2022 at 8:53 PM, Scrapmanson said:

That's kinda why I'm asking if my tests look like celiac or something else? 

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Because the Diam iga is positive, you could be a celiac even though the tTG-IGA is negative, especially if the total serum IGA turns out to be low. Were you eating regular amounts of gluten (2 slices of wheat bread daily or the equivalent) for 6-8 weeks prior to the blood tests? Don't cut back on gluten until all testing is complete.

[knitty kitty]

No, SIBO is a real thing...

The Influence of Small Intestinal Bacterial Overgrowth in Digestive and Extra-Intestinal Disorders

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279035/

And...

High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal

https://pubmed.ncbi.nlm.nih.gov/12738465/

And...

Excess carbohydrates in the diet can cause an imbalance in carbohydrate metabolism resulting in SIBO.  

Hiding in Plain Sight: Modern Thiamine Deficiency

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8533683/

[Scrapmanson]

  On 6/27/2022 at 9:00 PM, trents said:

Because the Diam iga is positive, you could be a celiac even though the tTG-IGA is negative, especially if the total serum IGA turns out to be low. Were you eating regular amounts of gluten (2 slices of wheat bread daily or the equivalent) for 6-8 weeks prior to the blood tests? Don't cut back on gluten until all testing is complete.

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Yeah I've never been gluten free so I've always ate normal. That's kinda why I went and got this other total iga test. If that comes back low then it leans toward celiac if it's normal then?

[trents]

  On 6/27/2022 at 9:04 PM, Scrapmanson said:

Yeah I've never been gluten free so I've always ate normal. That's kinda why I went and got this other total iga test. If that comes back low then it leans toward celiac if it's normal then?

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A low total IGA simply means there is a greater chance that your tTG-IGA was skewed toward the negative range. I wouldn't go so far as to say it would tip the scale toward have celiac disease. You should have more answers in two weeks.

[Russ H]

  On 6/27/2022 at 8:27 PM, Scrapmanson said:

Hey guys new here, I've flet horrible and can't seem to get any answers, just trying to see if this is possible celiac or something else. So this long road started about 7yrs ago my daughter got real sick and I started having burning stomach and lost some weight and such, so started going to Dr, for blood work and I got fobed off. Well since then I've had more issues and I'm still only diagnosed with gastritis and ibs. About 3 yrs agoI had CT scan all Clear, colonoscopy all clear, endoscopy with biospy showed mild chronic gastritis, blood work always good except slightly high mpv 11.7 with 11.6 as the standard. My symptoms include burning stomach, abdomen pain, back pain, bloating, tons of gas, white tongue, large sticky stool, floating stool, constipation, loose stool, I'm sure a few things I'm missing. Anyways had a celiac blood test done recently, and I'm scheduled for another endoscopy in 2 weeks. Here's my test results. I did go in today and ask for a total iga serum test, waiting on results. Thanks! 

Ttg iga neg .5<15

Ttg igg neg .8<15

Diam igg neg .4<15

Diam iga pos 22.5

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I take it the later 2 tests are for deamidated gliadin peptide antibodies? If so, do you have the standard range for the positive one?

[Scrapmanson]

  On 6/27/2022 at 9:21 PM, Russ314 said:

I take it the later 2 tests are for deamidated gliadin peptide antibodies? If so, do you have the standard range for the positive one?

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Yes it's also <15

[Russ H]

  On 6/27/2022 at 9:33 PM, Scrapmanson said:

Yes it's also <15

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That is curious. In children, DGP can show before tTG antibodies. You are an adult and have been symptomatic for 7 years and yet have a borderline positive DGP but no tTG.

If you are IgA deficient, you are not showing up on IgG so that would be perplexing.

Interesting.

[Scrapmanson]

  On 6/27/2022 at 10:20 PM, Russ314 said:

That is curious. In children, DGP can show before tTG antibodies. You are an adult and have been symptomatic for 7 years and yet have a borderline positive DGP but no tTG.

If you are IgA deficient, you are not showing up on IgG so that would be perplexing.

Interesting.

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Why perplexing? What r your thoughts on this? I have no idea, unless there's something else that can show slightly high dgp? 

[knitty kitty]

We've had other adult Celiacs here who only tested positive on DPG.  It's not unheard of.  

Anemia and Diabetes can affect antibody production.  

[Russ H]

  On 6/27/2022 at 10:30 PM, Scrapmanson said:

Why perplexing? What r your thoughts on this? I have no idea, unless there's something else that can show slightly high dgp? 

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Coeliac disease has a complicated and not completely understood immune process. On top of that, individuals respond very differently.

One of the proteins within gluten called gliadin is resistant to digestive enzymes and is not completely broken down to short peptide chains for absorption. The remaining large fragments are quite immunogenic. If it gets into the wall of the gut, one of the known fragments binds to an enzyme called tissue transglutaminase (tTG). As well as binding to the gliadin fragment, tTG removes an amide group creating a positively charged complex that is highly immunoreactive.  Immune cells chomp this complex up and present the components to other immune cells, leading to an immune response both to gluten and tTG. It is a complicated process but it bypasses the mechanisms to avoid self tolerance i.e. responding to tTG.

When the complex is chomped up for immune response, one of the things that is recognised is deamidated gliadin. Your results show a low positive to this but not to tTG. Low positive tTG can be caused by various conditions such as liver inflammation and Crohn's disease.

A low positive DGP alone is curious.

[Scrapmanson]

  On 6/27/2022 at 11:02 PM, Russ314 said:

Coeliac disease has a complicated and not completely understood immune process. On top of that, individuals respond very differently.

One of the proteins within gluten called gliadin is resistant to digestive enzymes and is not completely broken down to short peptide chains for absorption. The remaining large fragments are quite immunogenic. If it gets into the wall of the gut, one of the known fragments binds to an enzyme called tissue transglutaminase (tTG). As well as binding to the gliadin fragment, tTG removes an amide group creating a positively charged complex that is highly immunoreactive.  Immune cells chomp this complex up and present the components to other immune cells, leading to an immune response both to gluten and tTG. It is a complicated process but it bypasses the mechanisms to avoid self tolerance i.e. responding to tTG.

When the complex is chomped up for immune response, one of the things that is recognised is deamidated gliadin. Your results show a low positive to this but not to tTG. Low positive tTG can be caused by various conditions such as liver inflammation and Crohn's disease.

A low positive DGP alone is curious.

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Thanks for the detailed resp.... So r u saying it's very odd to only have low dgp? Should I get other tests done or maybe look elsewhere for diagnosis? My original endoscopy was negative for celiac a couple yrs ago... I'm serious so done with not knowing what is actually going on, thought I was finally finding an answer to feeling so bad all the time... Heres my test results 

[Russ H]

I wouldn't call it very odd as there is so much variation between people.  See what happens with your IgA test and endoscopy

A paper quoted in this review states:

  Quote

Notably, as shown in Fig. 1 of the study by Hoerter et al., the serum concentration of DGP antibodies cannot discriminate between DGP-positive celiac disease patients and cases regarded as “false positives.” Therefore, patients with discrepant results (tTG negative and DGP positive, or vice versa) should undergo duodenal biopsy.

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The celiac disease That Pays Dividends: More Than 15 Years of Deamidated Gliadin Peptide Antibodies

 

So, it is certainly possible to have -ve tTG IgA with +ve DGP IgA and have coeliac disease.

Edited June 28, 2022 by Russ314
Edited for clarity

[Scrapmanson]

I got my iga back came back normal 167

Range 40-350

Only thing came back in my entire blood test off was. Albumin/globulin ratio high of 2.2 in range 0.8 to 2.0

[Scrapmanson]

  On 6/28/2022 at 12:23 PM, Russ314 said:

I wouldn't call it very odd as there is so much variation between people.  See what happens with your IgA test and endoscopy

A paper quoted in this review states:

The celiac disease That Pays Dividends: More Than 15 Years of Deamidated Gliadin Peptide Antibodies

 

So, it is certainly possible to have -ve tTG IgA with +ve DGP IgA and have coeliac disease.

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I got my iga back came back normal 167

 

Range 40-350

 

Only thing came back in my entire blood test off was. Albumin/globulin ratio high of 2.2 in range 0.8 to 2.0

[Wheatwacked]

Hi , confusing times. How is your daughter doing? You have several indicators of malabsorption syndrome. Your stool could be choline deficiency whiich could be simply not eating enough or not absorbing it. The RDA (the mininimum required to stay healthy) is 3 large eggs a day. B12, B6, Choline, Folate and homocysteine blood tests would help identify.

1. Vitamin D Deficiency:  A study with 434 people found that lower blood vitamin D levels were associated with high MPV [18]. https://labs.selfdecode.com/blog/mpv/

 

  On 6/27/2022 at 8:27 PM, Scrapmanson said:

high mpv 11.7 with 11.6 as the standard.

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  On 6/29/2022 at 10:57 PM, Scrapmanson said:

Albumin/globulin ratio high of 2.2 in range 0.8 to 2.0

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"A total protein and A/G ratio test is often included as part of a comprehensive metabolic panel, a test that measures proteins and other substances in the blood. It may also be used to help diagnose kidney disease, liver disease, or nutritional problems."  https://medlineplus.gov/lab-tests/total-protein-and-albumin-globulin-a-g-ratio/

  On 6/27/2022 at 8:27 PM, Scrapmanson said:

diagnosed with gastritis and ibs

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  On 6/27/2022 at 8:27 PM, Scrapmanson said:

large sticky stool, floating stool, constipation, loose stool

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Smelly and sticky stools are typically a symptom of nutrient malabsorption. This means your body isn’t able to completely absorb and digest nutrients from your gastrointestinal tract due to damage to the small intestine, not having enough pancreatic enzymes, liver disease, HIV/AIDs, or other conditions.   https://www.webmd.com/digestive-disorders/what-to-know-about-floating-stools#:~:text=Smelly and sticky stools are,%2FAIDs%2C or other conditions.

  On 6/27/2022 at 10:20 PM, Russ314 said:

f you are IgA deficient, you are not showing up on IgG so that would be perplexing.

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"A high A/G ratio suggests underproduction of immunoglobulins as may be seen in some genetic deficiencies and in some leukemias....Following an abnormal total protein result and depending on the suspected cause, more specific tests are typically performed to make an accurate diagnosis. Some examples include liver enzyme tests, renal panel, serum protein electrophoresis, or tests for celiac disease or IBD. "  https://www.labcorp.com/help/patient-test-info/total-protein-and-albuminglobulin-ag-ratio

[Scrapmanson]

  On 6/30/2022 at 10:45 AM, Wheatwacked said:

Hi , confusing times. How is your daughter doing? You have several indicators of malabsorption syndrome. Your stool could be choline deficiency whiich could be simply not eating enough or not absorbing it. The RDA (the mininimum required to stay healthy) is 3 large eggs a day. B12, B6, Choline, Folate and homocysteine blood tests would help identify.

1. Vitamin D Deficiency:  A study with 434 people found that lower blood vitamin D levels were associated with high MPV [18]. https://labs.selfdecode.com/blog/mpv/

 

 

"A total protein and A/G ratio test is often included as part of a comprehensive metabolic panel, a test that measures proteins and other substances in the blood. It may also be used to help diagnose kidney disease, liver disease, or nutritional problems."  https://medlineplus.gov/lab-tests/total-protein-and-albumin-globulin-a-g-ratio/

 

Smelly and sticky stools are typically a symptom of nutrient malabsorption. This means your body isn’t able to completely absorb and digest nutrients from your gastrointestinal tract due to damage to the small intestine, not having enough pancreatic enzymes, liver disease, HIV/AIDs, or other conditions.   https://www.webmd.com/digestive-disorders/what-to-know-about-floating-stools#:~:text=Smelly and sticky stools are,%2FAIDs%2C or other conditions.

"A high A/G ratio suggests underproduction of immunoglobulins as may be seen in some genetic deficiencies and in some leukemias....Following an abnormal total protein result and depending on the suspected cause, more specific tests are typically performed to make an accurate diagnosis. Some examples include liver enzyme tests, renal panel, serum protein electrophoresis, or tests for celiac disease or IBD. "  https://www.labcorp.com/help/patient-test-info/total-protein-and-albuminglobulin-ag-ratio

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My daughter is good now, Thanks for asking. My total protein is Good. I did a total iga to see if that was deficient to see if that's why my Ttg tta didn't show positive, but it came back normal. So only things off was diam peptide of 22.3, and aga ratio barely high by .1

[Scrapmanson]

Just finished with my endoscopy, Dr wanted to check for celiac, so took biopsy but here's what it says, wondering what all this kinda means?  Does this stuff indicate posible celiac? So freaked about about stomach cancer! 

Impressions: normal esophagus, gastritis, duodenitis. 

Scattered moderate inflammation characterized by congestion (edema), erythema, and friability was found in gastric antrum.

Scattered mild inflammation characterized by congestion (edema) was found in duodenal bulb.

Said to see him in 4 weeks...wont know results till then. 

[trents]

About all you can say at this point is that the esophagus looks normal but the stomach and upper part of the small bowel don't look happy. The microscopic report on the status of the villi that line the small bowel is pending, which is the critical factor when diagnosing celiac disease.

[Scrapmanson]

OK guys finally got my results back,  doesn't llok like celiac from what I'm reading but I don't see my Dr for like 2 months so I'm kinda freaking out with what this says.... Heres my biospy report... 

[trents]

Nope, doesn't look like celiac disease but if you have celiac-like symptoms you may very well have NCGS (Non Celiac Gluten Sensitivity).

But, were you consuming significant amounts of gluten before the biopsy? If you had already gone gluten free for weeks or months then the testing would be invalidated. Did you also have celiac serum antibodies tested earlier? And if so, what were the results?

Edited August 13, 2022 by trents