Diagnosis

[Di Wallace]

I am very new to all this. My Grandson has just been diagnosed with Coeliacs. His consultant asked if anyone in the family has Graves Disease. I have and also Bile Acid Malabsorption. I went for a blood test, I think it was a TTg. It came back as 26 U/ml, not too sure what this means. Can anyone help please?

[trents]

Welcome to the forum, @Di Wallace! No apologies necessary for being a newbie. We all start at zero with this at one point in time. From the way you spelled "Coeliacs" I assume you are in the U.K. Unfortunately, U.K. doctors seem not to be very forthcoming with their patients when it comes to sharing details about their lab work and your system apparently doesn't allow you to access lab reports online as many of us can here in the U.S. through our various private healthcare systems.

So, here we go. There is more than one TTG test. But the most common one run by physicians is the TTG-IGA. You gave your score of 26 U/ml but you did not include the reference range for negative vs. positive for that test. There is not industry standard for ranges. Each lab uses their own scale. Is there a notation as to whether the result was deemed negative or positive?

Celiac disease is an autoimmune disorder. So is Graves. Autoimmune disorders tend to cluster. When you develop one you are more likely to develop others than is the general population and this is even more true with certain kinds of autoimmune disorders. That is why your grandson's consultant asked if anyone in the family had Grave's disease.

[Di Wallace]

Oh, sorry I just found some more info. Is this what you were referring to?

Neg 7U/ml

Equivocal 7 - 10U/ml

Positive 10 U/ml

[Wheatwacked]

26 U/ml would therefore be positive.

Some thoughts on your BAM Bile Acid Malabsorption.  Celiac Disease caused villi damage in your ileum could be one cause of your BAM.  In addition 90% of westerners do not consume enough choline.  Perfect storm.

• The major fate of choline is conversion to phosphatidylcholine (the main constituent of lecithin)
• Bile is composed of various components, including cholesterol, bile acids and lecithin.
• Bile salts inhibit cholesterol 7alpha-hydroxylase, decreasing the synthesis of bile acids.
•  Low choline may contribute to poor memory, fatty liver, reduced bile flow and high homocysteine
• Due to lower oestrogen concentrations, postmenopausal women are more susceptible to the risk of organ dysfunction in response to a low-choline diet.

• The majority of Europeans, American, Canadian and Australian populations are not meeting choline AI recommendations.

• de novo synthesis of choline alone is not enough to meet human requirements.
•  lecithin enhances bile secretion and prevents bile acid-induced cholestasis (reduction or stoppage of bile flow).
• Work based on the NHANES datasets showed that only around 11% of American adults achieve the IOM AI for choline. In Europe it has also been found that average choline intakes are below AI thresholds set by the IOM.
• bile acids are efficiently reabsorbed from the ileum, part of the small intestine that can have damaged villi from untreated Celiac Disease.

How Celiac Disease May Affect Your Risk for Gallbladder Disease

Could we be overlooking a potential choline crisis in the United Kingdom?

Physiology, Bile Secretion

[trents]

1 hour ago, Di Wallace said:

Oh, sorry I just found some more info. Is this what you were referring to?

Neg 7U/ml

Equivocal 7 - 10U/ml

Positive 10 U/ml

Yes, that's it. If your score was 10x normal you would likely be declared as a celiac without further diagnostics. Since it is not, you will likely be recommended for an endoscopy with biopsy to check for damage to the small bowel villous lining that is characteristic of celiac disease.

[Di Wallace]

So, does this mean, that as it is only 16 points over the positive mark, that it may not be Coeliac?

[trents]

18 minutes ago, Di Wallace said:

So, does this mean, that as it is only 16 points over the positive mark, that it may not be Coeliac?

Yes, it is possible but not probable that it could mean that.

Edited March 3, 2024 by trents

[Di Wallace]

Thanks