Help with Lab Results and diagnosis

[JJDN]

Hi, I am hoping someone can give me a reason why only one of my Celiac Panel labs was positive.

I had the following labs done (have never been gluten-free):  TTG IGG (neg), TTG IGA (neg), DGP IGA (pos), DGP IGG (neg), IGA (normal).

Biopsy also negative with upper endoscopy (did show significant esophagus inflammation and some eosinophils, not enough for EOE diagnosis).  I have never seen an MD in the clinic, just the GI nurse practitioner, who gave no explanation on the labs after the biopsy was neg.  She only wanted to move on to doing a colonoscopy to check for bleeds due to my iron deficiency. 

I can't find any info on google for the isolated positive DGP-IGA.  I saw positives on the AGA test may mean gluten sensitivity.  And isolated positive DGP-IGG may be Celiac ... but nothing on isolated positive DPG-IGA.

Symptoms: bloating, indigestion, cramping, iron deficiency (ferritin was a 4, can't get it above 20 after 1 year of iron supplements).  I tested positive for SIBO also a few years ago and have not retested recently.

Any info on what other diagnosis a positive DGP-IGA means would be appreciated!

Thanks

 

[trents]

Welcome to the forum, JJDN!

It is not unusual for the tTG-IGA to be negative but one or more other celiac antibodies to be positive. I would not focus on the fact that the DGP-IGA is the only antibody test that was positive. It is too bad your physician did no also order an EMA.

But if you have celiac disease we would expect the biopsy to be positive in view of the fact that you were still consuming gluten. Your symptoms are certainly congruent with celiac disease. Have you considered NCGS (Non Celiac Gluten Sensitivity)? It is 10x more common than celiac disease and shares many of the same symptoms with Celiac disease. Currently, there is no test for NCGS so celiac disease must first be ruled out. The antidote is the same for both, that is, life-ling abstinence from gluten. Some experts believe that NCGS can be a precursor to celiac disease.

Concerning your low iron stores, that could be due to many things and it is good that you are getting a lower GI done. Have you been checked for B12 levels and pernicious anemia? B12 is necessary for the assimilation of iron. People with pernicious anemia do not absorb B12 properly.

Edited February 8, 2023 by trents

[JJDN]

5 minutes ago, trents said:

Welcome to the forum, JJDN!

It is not unusual for the tTG-IGA to be negative but one or more other celiac antibodies to be positive. I would not focus on the fact that the DGP-IGA is the only antibody test that was positive. It is too bad your physician did no also order an EMA.

But if you have celiac disease we would expect the biopsy to be positive in view of the fact that you were still consuming gluten. Your symptoms are certainly congruent with celiac disease. Have you considered NCGS (Non Celiac Gluten Sensitivity)? It is 10x more common than celiac disease and shares many of the same symptoms with Celiac disease. Currently, there is no test for NCGS so celiac disease must first be ruled out. The antidote is the same for both, that is, life-ling abstinence from gluten.

Concerning your low iron stores, that could be due to many things and it is good that you are getting a lower GI done. Have you been checked for B12 levels and pernicious anemia? B12 is necessary for the assimilation of iron. People with pernicious anemia do not absorb B12 properly.

Hi, thanks for the reply.  I did have B12 tested and it was normal.  Colonoscopy was also normal.  I don't know if any of these other symptoms weigh in, but I have had chronic fatigue-like symptoms for a good 20 years.  I also was diagnosed with moderate interstitial cystitis (by cystoscopy).  I also have numerous food allergies (nuts, soy, many fruits and vegetables, confirmed with testing).

I was hoping to have a definitive diagnosis before giving up gluten for NCGS possibility. 

Does the positive DPG-IGA occur in any other diseases?  Like autoimmune diseases?

Thanks!

 

[trents]

Not sure if a positive DPG-IGA occurs in other illnesses. But, you could trial a gluten free diet for a few weeks and see if your symptoms improve. But when you have multiple food allergies/sensitivities it can be difficult to sort things out.

[knitty kitty]

Anemia not only affects red blood cell production, it can affect white blood cells and antibody production, too.  

A positive is a positive.  

I found this study...

Antibodies against deamidated gliadin peptides identify adult coeliac disease patients negative for antibodies against endomysium and tissue transglutaminase

https://pubmed.ncbi.nlm.nih.gov/20456302/

[Scott Adams]

There is some info here on the blood tests, but I agree, that a positive test may indicate celiac disease, or at least NCGS. 

It's unclear if your upper GI included a full endoscopy for celiac disease, but if not, that would likely be your next step after a positive blood test, and you would need to keep eating gluten daily until all celiac disease tests are completed: