TTG-IGA test suddenly goes >100 after 4 years < 30

[Graziella Brincat]

Hi there,

my 73 year old mother has been diagnosed as Celiac four years ago. She has been following a strickt diet and has reduced her IGA test from > 100 to around 23 in her last test in February 2022. In August she went for her routine check and her blood work came back > 100. She has not been losing weight or feeling any new symptoms other than changes in blood pressure. She has eaten out on occasion and she always asks servers about food options for her, she has always done this but let's say there might have been some contamination in the past months post-COVID. Could this have increased her results so drastically from 23 to > 100? Her doctor is not really helpful, sent her to her dietician who told her that she must be slacking and the problem is cross-contamination. Since her last test she has stayed home being extra vigilant and will repeat the test in November.

Is there anything we should be looking at, should she have a biopsy taken or other take other tests for further investigation?

Thank you!

[trents]

Welcome to the forum, Graziellia! 

Is your mother still consuming dairy and oats, even gluten free oats?

What medications is she taking?

There are some foods and some medications that mimic the effect of gluten on the small bowel villi and cause inflammation. What about vitamins and supplements? Are they all gluten free? Wheat starch can be used as a filler in pills.

Is the household your mother lives in gluten free or are other people in the house still consuming gluten?

Another thing to be aware of is that food companies can and do make changes to ingredients without notification. What was once gluten free may not be any longer. So check all processed food products in your cupboard for wheat, barley and rye. 

[Graziella Brincat]

Thank you for your reply. She does take dairy not sure about oats. She started taking blood pressure medication, I don’t think it occurred to her to ask if it’s gluten free. 
 

The household is not 100% gluten free but it never was. In the sense that she was doing well before but not more and her house habits have not changed. 
 

How does the blood test work? Say for example if you eat a cookie before the test would you spike the test but then it comes down after a few days or will it take months to recover? 
 

thank you again!

[trents]

As a matter of fact, one of the meds that can damage the small bowel villi is a blood pressure medication.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198241/

PPI's (acid blockers) and NSAIDs like Advil can also damage villi.

General non-gluten causes of villous atrophy: 

 

 

Having said all that, in the majority of cases where celiacs who experience antibody rebounds, the cause is gluten getting back into the diet somehow. Living in a household with gluten eaters significantly increases the risk of gluten finding it's way into your mom's food.

No. Eating a cookie immediately before a blood test for celiac antibodies would not cause a spike in antibodies. The blood test is not measuring gluten, it is measuring the antibody levels that results from the inflammation in the small bowel lining caused by gluten consumption over time. It would take weeks of gluten consumption to significantly drive up antibody levels in the blood.

I also offer this primer: 

 

Edited October 22, 2022 by trents

[Graziella Brincat]

Thank you so much for your helpful replies, I appreciate it.

[RMJ]

Clearly something changed between February and August.  If all tests were run at the same lab, that amount of increase would not be due to a one time contamination or mistake. I would look at what has changed in her diet (including any drugs/supplements) and her environment.  For example she using a new brand of gluten free flour (that increased my antibodies once) or other food? Has she eaten regularly at a new restaurant?  Is someone in the household doing more baking with regular flour. Etc.

It may take some time for her levels to decrease again, as it probably did when she first went gluten free. Unfortunately with a result of >100 you don’t know if it is 1000 or 101, so if the November test is still >100 you won’t know if there has been a decrease or not.

Good luck!

[Graziella Brincat]

Thank you RMJ, I don’t know the answers here, clearly it’s more nuanced than I thought. I will pass on the info however and help her get back on the right track.