Am I coeliac?

[Sumara]

In Nov 2022 I had a blood test that came back with a weak positive for Coeliac. I had been off eating any bread and pasta products that month so the doctor recommended I go back to eating gluten and do a repeat blood test a week later. After my second blood test the doctor said I was still weak positive and not to worry, it meant nothing, and to just carry on as normal. However since then I've done a bit of reading and seen that any weak positive is still a positive for Coeliac and that I should be on a gluten free diet. I was also not offered an endoscopy biopsy, should I have had this to confirm a positive diagnosis? 

My primary symptoms are symptoms of fatigue, brain fog, a little bloating, deteriorating eyesight, weight gain, some joint pain, inflammation.

Any support or information would be amazing, thanks!

Sumara

(these are my first and second blood test results)

anti TTG IgA
21.2 CU (< 20.0)

TTG IgA Interpretation
Weak Positive

IgA
1.0 g/L (0.8 - 4.0)

Endomysial Ab
Negative

Deamidated Gliadin Peptide IgG
12 CU (< 20)

DGP IgG Interpretation
Negative

These are my second blood test results, slightly higher TTG Iga, but lower Deamidated gliadin Peptide.

anti TTG IgA
22.0 CU (< 20.0)

TTG IgA Interpretation
Weak Positive

IgA
0.9 g/L (0.8 - 4.0)

Endomysial Ab
Negative

Deamidated Gliadin Peptide IgG
10 CU (< 20)

DGP IgG Interpretation
Negative

[trents]

The Mayo Clinic guidelines for a pretest gluten challenge is the daily consumption of two slices of wheat bread (or the gluten equivalent) for 6-8 weeks leading up to the day of the blood draw and fro two weeks leading up to the day of the endoscopy/biopsy. You fell well short of that and no doubt it skewed your antibody test numbers downward. Your physician gave you bad guidance. You either need to go back on gluten for around two months if you choose to repeat the antibody testing or for two weeks straight if you decide to go forward with the endoscopy/biopsy.

The other option would be to forego further testing and go all in on gluten-free eating to see if the symptoms improve. That's a reasonable option if you don't care about an official diagnosis that goes in your medical chart. IMO, it is likely you have celiac disease because of the weak positive tTG-IGA as it is 98% accurate. But keep in mind that many people have trouble being consistent on a gluten-free diet without an official diagnosis and in some countries, like the UK, an official diagnosis qualifies you for government stipends for buying gluten-free food.

[Scott Adams]

Since you had two positive blood tests already, you should eb able to just do the endoscopy/biopsy, especially if you explain that you were gluten-free for a time before your blood tests (during the 6-8 weeks before). For the biopsy you would need to eat the same 2 slices of wheat bread daily for 2 weeks beforehand, but if you need further confirmation be sure to discuss with your doctor getting a biopsy (at least 4-6 samples should be taken).