Thoughts on Test Results? - High DGP IGG

[ballerina96]

Hello! New user here (27F, 5'7" 125lbs). My PCP recently ordered me a full celiac panel based on the symptoms I described during my physical. My symptoms include digestive issues (bloating, gas, irregular BMs), heartburn (have had times where it has been so bad I've vomited, like after pizza), frequent canker sores (sometimes more than 1 at a time), anixety, and skin issues (redness and dozens of tiny whiteheads that appear on my face a day or so after eating gluten + sugar heavy foods).

Here are results:

• Tissue Transglutaminase IgA Ab = < 1 (not detected)
• Tissue Transglutaminase IgG Ab = < 1 (not detected)
• Gliadin (Deamidated Peptide) AB, IGA = < 1 (not detected)
• Gliadin (Deamidated Peptide) AB, IGG = 57 - HIGH (value interpretation: > or = 15 Antibody detected)
• Immunoglobin A (IgA) = 93 (Normal range 47-310)
• Red Blood Count = 3.85 (Normal range: 3.8-5.1) 
• Hemoglobin = 12.6 (Normal range: 11.7-15.5)

My doctor followed up with the message: "Your testing suggests celiac disease. I am making a referral for you to see a gastroenterologist for an endoscopy." He also said the rest of my blood work looks good.

I've read mixed/ confusing things on the DGP IGG results - what does an isolated positive mean? Why would I be negative in the other categories? Do you think it's likely I have celiac or just NCGS or another autoimmune issue? Or potentially 'early stage' celiac?

It's also worth nothing that I eat very healthy/whole foods and eat gluten free around 85% of the time, but sometimes I'll 'cheat' on the weekends like going out to dinner.. In which case I know I'll pay the price in stomach issues, breakouts etc. Since I wasn't planning on getting tested for celiac when I went to my annual physical, and the lab test was only 5 days later, I only had 5 days to fill myself with gluten haha.

My GI follow up appointment is in a month but curious to hear if anyone has had similar results and can shed light. Appreciate any insight. Thank you! 

[trents]

Welcome to the forum, ballerina96!

We sometimes see this pattern of antibody test results for those who have already started on the gluten free diet or who just don't eat much gluten anyway. That is, elevated IGG with other antibody tests being negative. And five days of concentrated gluten intake prior to the antibody testing blood draw is not likely to make up for that. You are blessed to have a physician who was knowledgeable enough about celiac disease to order a more complete antibody panel and not just the tTG-IGA.

If you will consume significant amounts of gluten between now and your endoscopy/biopsy date, you should create conditions favorable for a valid result from this procedure. The Mayo Clinic guidelines for a pre scoping/biopsy for celiac disease is the daily consumption of two slices of wheat bread (or the gluten equivalent) for two weeks prior to the procedure. Then you will be able to discern whether a problem with gluten is due to celiac or NCGS. Either way, the antidote is the same: lifelong avoidance of gluten.

[Scott Adams]

This article might be helpful. It breaks down each type of test, and what a positive results means in terms of the probability that you might have celiac disease. In your case it would make sense to get the endoscopy done based on your results. 

 

 

[Russ H]

On 11/10/2023 at 5:44 PM, ballerina96 said:

Hello! New user here (27F, 5'7" 125lbs). My PCP recently ordered me a full celiac panel based on the symptoms I described during my physical. My symptoms include digestive issues (bloating, gas, irregular BMs), heartburn (have had times where it has been so bad I've vomited, like after pizza), frequent canker sores (sometimes more than 1 at a time), anixety, and skin issues (redness and dozens of tiny whiteheads that appear on my face a day or so after eating gluten + sugar heavy foods).

Here are results:

• Tissue Transglutaminase IgA Ab = < 1 (not detected)
• Tissue Transglutaminase IgG Ab = < 1 (not detected)
• Gliadin (Deamidated Peptide) AB, IGA = < 1 (not detected)
• Gliadin (Deamidated Peptide) AB, IGG = 57 - HIGH (value interpretation: > or = 15 Antibody detected)
• Immunoglobin A (IgA) = 93 (Normal range 47-310)
• Red Blood Count = 3.85 (Normal range: 3.8-5.1) 
• Hemoglobin = 12.6 (Normal range: 11.7-15.5)

My doctor followed up with the message: "Your testing suggests celiac disease. I am making a referral for you to see a gastroenterologist for an endoscopy." He also said the rest of my blood work looks good.

I've read mixed/ confusing things on the DGP IGG results - what does an isolated positive mean? Why would I be negative in the other categories? Do you think it's likely I have celiac or just NCGS or another autoimmune issue? Or potentially 'early stage' celiac?

It's also worth nothing that I eat very healthy/whole foods and eat gluten free around 85% of the time, but sometimes I'll 'cheat' on the weekends like going out to dinner.. In which case I know I'll pay the price in stomach issues, breakouts etc. Since I wasn't planning on getting tested for celiac when I went to my annual physical, and the lab test was only 5 days later, I only had 5 days to fill myself with gluten haha.

My GI follow up appointment is in a month but curious to hear if anyone has had similar results and can shed light. Appreciate any insight. Thank you! 

The proteins in wheat are problematic because mammals cannot completely digest them and large fragments remain as they pass through the gut. A fragment of one of the proteins called gliadin binds to an enzyme found in the gut called tissue transglutaminase (tTG2) and forms a highly immunogenic complex - in this process it loses an amide group and become positively charged, hence 'deamidated gliadin peptide or DGP'. Coeliac disease is a specific immune reaction to the complex which generate antibodies both to DGP and to tTG2. However, it is common for people without coeliac disease to have antibodies just to DGP. Hence, isolated DGP has very poor specificity for coeliac disease. This does not mean that you don't have coeliac disease or NCGS, it just means that the results are not conclusive and merit further investigation, especially considering your symptoms. (If, for example, you had 10x the standard range for tTG2, you would almost certainly have coeliac disease.)