Lab interpretation

[LAF14614]

Hi Everyone, thanks for taking the time to look at this. I recently had some lab work done by my GI doctor and have an upper endoscopy scheduled in 1 week. I received my lab results yesterday and want to make sure I understand the results prior to seeing my doctor for the scope so that I know the proper questions to ask. Here are my results:

GLIADIN (DEAMIDATED) AB (IGG)

<1.0

U/mL 

See Note 1

GLIADIN (DEAMIDATED) AB (IGA)

29.8 H

U/mL 

See Note 1

TISSUE TRANSGLUTAMINASE AB, IGG

<1.0

U/mL 

See Note 1

TISSUE TRANSGLUTAMINASE AB, IGA

<1.0

U/mL 

See Note 1

ENDOMYSIAL ANTIBODY SCR (IGA) W/REFL TO TITER

NEGATIVE

Reference Range: NEGATIVE

IMMUNOGLOBULIN A

166

Reference Range: 47-310 mg/dL

I also had a CBC, BMP, B12 level, Folate level and all that checked out normal with the exception of my absolute eosinophils which came back elevated (not sure if that has anything to do with a possible Celiac diagnosis)

ABSOLUTE EOSINOPHILS 

762 H Reference Range: 15-500 cells/uL

All labs were completed on on a normal gluten containing diet, and I have never suspected I had any issues with gluten, up until receiving these lab results. 

My symptoms that initiated this lab work are pretty vague and all started after I got Salmonella food poisoning (confirmed with lab testing) 10 months ago. Prior to the Salmonella infection I haven't really ever had GI issues in my life, but I do have mild eczema and skin sensitives. Since getting Salmonella I have episodes of nausea and diarrhea that come on suddenly and last for about 2 days, then go away until the next episode. During these episodes I also get chills and shaking. When I feel good, I feel normal, and when I'm sick and having one of these episodes, I feel terrible. After seeing my GI doctor with these symptoms he ordered the lab work and upper GI scope because he was suspecting some sort of Mast cell issue and started me on Zyrtec and Pepcid for  histamine blocking properties. 

Basically, I would like some advice on any questions I should ask, what my labs could potentially mean, and what the different scenarios could be. I understand that if my biopsy on my endoscopy is positive that will be the definitive diagnosis for Celiac, but what if my biopsy is negative? Is it strange that only 1 of my tests on the Celiac panel came back positive, and the others were completely negative? What are some other things, besides celiac, that can cause at elevated GLIADIN (DEAMIDATED) AB (IGA)?  Even if I don't have Celiac according to a biopsy, does this lab being elevated indicate definitively that my body is reacting negatively to gluten? I like to be prepared and armed with knowledge going into medical appointments. I don't have any other medical problems or diagnoses, and would consider myself to be a healthy 36 year old female. Thanks so much for your time if you made it to the end of all this and am looking forward to any responses. 

 

[trents]

LAF14614, welcome to the forum!

Your high GLIADIN (DEAMIDATED) AB (IGA) strongly suggests celiac disease but doesn't rule out other causes.

"More than 9 in 10 people with untreated celiac disease have higher-than-normal levels of DMG antibodies. But very few people without the disease do." https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=dgp_celiac_disease

I could not find specific information about non celiac causes of elevated deamidated gliadin AB (IGA) but realize that not everyone's immune system responds the same to a given threat. That is the value of running multiple tests for celiac disease.

Keep us posted.

[LAF14614]

Thanks so much for responding to my post! I really appreciate your time. Can you think of any specific questions I should ask my GI doctor before my upper endoscopy? Also, in your opinion, even if my biopsy is "negative" for celiac does this elevation in my labs mean my immune system is reacting negatively to gluten?

[trents]

I'll answer the second question first. There is another gluten-related disorder known as NCGS (Non Celiac Gluten Sensitivity) which shares many of the same symptoms with celiac disease, is 10x more common than celiac disease, but for which there is no definitive test. Celiac disease must first be ruled out. NCGS does not damage the villi of the small bowel as does celiac disease so it would not show anything on a biopsy and will not throw positives for some of the more specific celiac antibody tests, particularly the tTG-IGA which is the most common dx test for celiac disease that doctors order. My thinking is that NCGS may trigger positives for some of the other, less specific antibody tests that are included in a full celiac panel. I'm just basing this on patterns I have seen in self-reporting by our forum participants who have atypical results when celiac panels are done. That is to say, the tests that are more specific for celiac disease are negative but one or more of the peripheral antibody tests are.

Concerning your first question, I would ask the GI doc who will be doing the biopsy to take at least four samples each from both the duodenum and the duodenum bulb. Damage can be patchy and is often missed by those who do less than thorough sampling.

Edited September 28, 2022 by trents