Son’s celiac labs

[gladwella]

Some of my son’s labs came back and I’m trying to understand what they may mean. 
tTG-IgA = negative 

DMG-IgA = positive 

DMG-IgG = negative 

EMA = still waiting on these

I understand this group cannot diagnose, but am just trying to get a handle on what may be going on. If two of the three returned are negative does this mean it’s not celiac and more of a gluten sensitivity or if any of the results returned are positive does that mean further work up/biopsy is warranted?

[gladwella]

  On 2/26/2024 at 8:03 PM, gladwella said:

Some of my son’s labs came back and I’m trying to understand what they may mean. 
tTG-IgA = negative (0.5) range: 0.0-14.9

DMG-IgA = positive (26.3) range: 0.0-14.9

DMG-IgG = negative (0.4) range 0.0-14.9

EMA = still waiting on these

I understand this group cannot diagnose, but am just trying to get a handle on what may be going on. If two of the three returned are negative does this mean it’s not celiac and more of a gluten sensitivity or if any of the results returned are positive does that mean further work up/biopsy is warranted?

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[trents]

Did you mistype? We are used to seeing DGP-IGA and DGP-IGG instead of "DMG-".

The two most targeted tests you had run for celiac disease are the tTG-IGA and the EMA. The other two are not as specific for celiac disease. The tTG-IGA is the most popular blood antibody test run by physicians for celiac disease. It combines good sensitivity with good specificity. The EMA is is an older test but quite specific. It is expensive to run and has given way to the tTG-IGA which accomplishes much the same thing and is less expensive. The positive DMG-IgA could possible indicate celiac disease but is less specific so positives can be caused by other things and is sometimes very helpful, especially when total IgA count is low or if someone has already been cutting back on gluten before testing.

Some questions:

1. How old is your son? Children's immune systems are immature and sometimes don't respond typically to celiac antibody testing the same way as do adults. Some of the secondary antibody tests such as the DGP-IGG and DGP-IGA can be helpful in spotting celiac disease in these cases.

2. Before the celiac blood antibody tests were run, had he been limiting his consumption of gluten to avoid unpleasant symptoms? If so, this can sabotage the testing and cause false negatives.

[gladwella]

Thank you for responding! Yes, I did mistype, apologies for that, this is all still very new. The Deamidated Gliadine IgA was positive while the IgG was negative. 

1. He is 9 with a long history of GI issues and abdominal pain 

2. We hadn’t restricted gluten yet but don’t have a gluten heavy diet in general. He has been food restricting for about a month (we attributed it to stress), so that could likely throw off the results some. I hadn’t considered that.

 

  On 2/26/2024 at 8:28 PM, trents said:

Did you mistype? We are used to seeing DGP-IGA and DGP-IGG instead of "DMG-".

The two most targeted tests you had run for celiac disease are the tTG-IGA and the EMA. The other two are not as specific for celiac disease. The tTG-IGA is the most popular blood antibody test run by physicians for celiac disease. It combines good sensitivity with good specificity. The EMA is is an older test but quite specific. It is expensive to run and has given way to the tTG-IGA which accomplishes much the same thing and is less expensive. The positive DMG-IgA could possible indicate celiac disease but is less specific so positives can be caused by other things and is sometimes very helpful, especially when total IgA count is low or if someone has already been cutting back on gluten before testing.

Some questions:

1. How old is your son? Children's immune systems are immature and sometimes don't respond typically to celiac antibody testing the same way as do adults. Some of the secondary antibody tests such as the DGP-IGG and DGP-IGA can be helpful in spotting celiac disease in these cases.

2. Before the celiac blood antibody tests were run, had he been limiting his consumption of gluten to avoid unpleasant symptoms? If so, this can sabotage the testing and cause false negatives.

Expand Quote  

 

[trents]

It is also possible your son has NCGS (Non Celiac Gluten Sensitivity). NCGS shares many of the same symptoms with celiac disease but does not damage the villous lining of  the small bowel as does celiac disease. NCGS is 10x more common than celiac disease but there is no definitive test for it at the present time. Celiac disease must first be ruled out. The antidote is the same, however, and that is complete abstinence from gluten for life. Some experts feel that NCGS can be a precursor to celiac disease. When you are satisfied that all testing for celiac disease is done, it would seem the next logical step would be to put your son on a strict gluten free diet and see if his symptoms improve.

[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. One test that always needs to be done is the IgA Levels/Deficiency Test (often called "Total IGA") because some people are naturally IGA deficient, and if this is the case, then certain blood tests for celiac disease might be false-negative, and other types of tests need to be done to make an accurate diagnosis. The article includes the "Mayo Clinic Protocol," which is the best overall protocol for results to be ~98% accurate.

 

 

[gladwella]

Trents & Scott, thank you so much for the information! This has given me some excellent resources and information to consider!