Trying to read my lab results

[Bayb]

Hi, I received my labs via email yesterday and have not heard back from my doctor yet. Can anyone tell me if these results indicate I have Celiac? 

 

 

Endomysial Antibody IgAPositive 

Ft-Transglutaminase (tTG) IgA6  H0-3 (U/mL)

- Negative 0 - 3

- Weak Positive 4 - 10

- Positive >10

- Tissue Transglutaminase (tTG) has been identified as the endomysial antigen. Studies have demonstrated that endomysial IgA antibodies have over 99% specificity for gluten-sensitive enteropathy.

FImmunoglobulin A, Qn, Serum55  L87-352 (mg/dL)

Ft-Transglutaminase (tTG) IgG183  H0-5 (U/mL)

- Negative 0 - 5

- Weak Positive 6 - 9

- Positive >9

[trents]

You have three celiac disease specific antibody tests that are positive: Endomysial  Antibody IGA (aka, EMA), tTG-IGA, and tTG_IGG. Furthermore, your Immunoglobulin A at 55 is low, meaning you are IGA deficient. This one is not an antibody test for celaic disease per se but a measure of "total IGA" levels and if low (yours is low) it can suppress the individual antibody scores and even cause false negatives. So, yes, it definitely looks like you have celiac disease.  

Do not yet begin a gluten free diet as your physician may refer you to a GI doc for an endoscopy/biopsy of the small bowel lining for confirmation of the antibody testing.

This may help: 

 

[Scott Adams]

I agree, and hopefully your doctor will contact you soon about the next step, which will likely be an endoscopy to confirm your diagnosis.

Do you have celiac disease symptoms? 

[Bayb]

Hi Scott, yes I have had symptoms for years and this is the second GI I have seen and he could not believe I have never been tested. He called later today and I am scheduled for an endoscopy. Is there a way to tell how severe my potential celiac is from the results above? What are the chances I will have the biopsy and come back negative and we have to keep searching for a cause? 

[Scott Adams]

In general studies have shown that tTg-IgA levels have a correlation with villi damage in those with celiac disease, and your levels are in the "weak positive" range, which could mean that you are in the early stages of developing celiac disease, or that you haven't been eating much gluten before you took the test.

I would consider trying a gluten-free diet, even if your biopsy results end up being negative, to see if your symptoms go away.

Here is more info about how to do a gluten challenge for a celiac disease blood panel, or for an endoscopy:

  Quote

"...in order to properly diagnose celiac disease based on serology and duodenal histology, doctors need patients to be on gluten-containing diets, even if they are causing symptoms, and this is called a "gluten challenge."

• Eat gluten prior to celiac disease blood tests: The amount and length of time can vary, but is somewhere between 2 slices of wheat bread daily for 6-8 weeks and 1/2 slice of wheat bread or 1 wheat cracker for 12 weeks 12 weeks;
• Eat gluten prior to the endoscopic biopsy procedure: 2 slices of wheat bread daily for at least 2 weeks;

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and this recent study recommends 4-6 slices of wheat bread per day:

 

 

[Bayb]

Hi Scott, 

My biopsy results from the endoscopy came back this morning. I have my appointment on Thursday but from what I understand, this is saying I have Celiac.

"Microsopic Findings
duodenal bulb and second part of the duodenum - Microscopic review of the small bowel biopsy reveals increased intraepithelial lymphocytes with villous blunting or distortion. There is also active inflammation in the epithelium. The lamina propria is expanded by a dense chronic inflammatory infiltrate. Findings such as these may be consistent with early or partially treated celiac sprue. Correlation with clinical, endoscopic and sero lo gic data with determination of anti-endomysial and anti-tissue transglutaminase antibodies is required.
stomach antrum and body - There is chronic inflammation without active component. No significant atrophy is noted. H pylori are not seen on giemsa stain and intestinal metaplasia is not seen on H&E stain. These stains are performed due to nature and concern / indications per requisition received and pathology seen.
Gross
1. Duodenal bulb and second part of the duode num. Submitted in: Specimen 1 The tissue is received in formalin. It consists of multiple tan portion(s) of tissue, measuring up to 4 mm.
The tissue is entirely submitted as 1A.
2. Stomach antrum and body. Submitted in: Specimen 2 The tissue is received in formalin. It consists of 3 tan portion(s) of tissue, measuring up to 5 mm. The tissue is entirely submitted as 2A.
EB 5.29.24
Microscopic review supports the diagnosis. All controls show appropriate reactivity."

[trents]

Your understanding is correct. It actually states that the findings "may be consistent with early or partially treated celiac sprue" and that "microscopic review supports the diagnosis" (from the bloodwork, that is). Partially treated celiac sprue would refer to someone with celiac disease who had already embarked on a gluten free diet and had experienced some healing. "Sprue" is an older term referring to celiac disease. It's like "pizza pie." 

[Bayb]

Is it strange that prior to my biopsy I increased my gluten intake. In reference to the experiencing some healing?

[trents]

  On 6/4/2024 at 2:33 PM, Bayb said:

Is it strange that prior to my biopsy I increased my gluten intake. In reference to the experiencing some healing?

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Caught in the early stages or patchy damage is more likely in your case.

At any rate, since your testing is complete it is now time for you to begin the gluten free diet: https://www.celiac.com/celiac-disease/the-gluten-free-diet-101-a-beginners-guide-to-going-gluten-free-r1640/

[Scott Adams]

  On 6/4/2024 at 1:53 PM, Bayb said:

Hi Scott, 

My biopsy results from the endoscopy came back this morning. I have my appointment on Thursday but from what I understand, this is saying I have Celiac.

"Microsopic Findings
duodenal bulb and second part of the duodenum - Microscopic review of the small bowel biopsy reveals increased intraepithelial lymphocytes with villous blunting or distortion. There is also active inflammation in the epithelium. The lamina propria is expanded by a dense chronic inflammatory infiltrate. Findings such as these may be consistent with early or partially treated celiac sprue. Correlation with clinical, endoscopic and sero lo gic data with determination of anti-endomysial and anti-tissue transglutaminase antibodies is required.
stomach antrum and body - There is chronic inflammation without active component. No significant atrophy is noted. H pylori are not seen on giemsa stain and intestinal metaplasia is not seen on H&E stain. These stains are performed due to nature and concern / indications per requisition received and pathology seen.
Gross
1. Duodenal bulb and second part of the duode num. Submitted in: Specimen 1 The tissue is received in formalin. It consists of multiple tan portion(s) of tissue, measuring up to 4 mm.
The tissue is entirely submitted as 1A.
2. Stomach antrum and body. Submitted in: Specimen 2 The tissue is received in formalin. It consists of 3 tan portion(s) of tissue, measuring up to 5 mm. The tissue is entirely submitted as 2A.
EB 5.29.24
Microscopic review supports the diagnosis. All controls show appropriate reactivity."

Expand Quote  

I agree with @trents and it sounds like your biopsy results indicate changes in your small intestine consistent with celiac disease, including increased intraepithelial lymphocytes and villous blunting. These findings suggest inflammation and damage typical of celiac sprue, but final diagnosis will depend on correlating these results with your clinical symptoms and serological tests, such as anti-endomysial and anti-tissue transglutaminase antibodies. Your stomach shows chronic inflammation without significant atrophy or H. pylori infection. Your appointment on Thursday should provide more clarity, but it's a good idea to prepare for a discussion about celiac disease and next steps for treatment.

Once your doctor instructs you to go on a gluten-free diet (I assume they will) this article will be helpful: