High IGA antigliadin, everything else normal, what does this mean?

[SMK7]

Hi, I would be so grateful for any help understanding my blood test results, below. I have a Dr appt with GI nurse in a couple of weeks. What could be causing this weird result? Do I need to keep going with further tests? Is it worth just redoing the bloodwork if it’s a false positive?
 

results:

tTG Ab,IgG <1 normal

tTG Ab,IgA<1 normal

IgA 136 normal range

Gliadin Ab IgA >250 HIGH

GLIADIN(DEAMIDATED) AB, IGG 4.6 normal 

[trents]

Welcome to the forum, SMK7!

It could be a false positive since your total IGA at 136 is within normal range. But it could also mean you have celiac disease but your immune system responds atypically or you have been eating a low gluten diet.

Yes, I would get the blood test repeated soon in several weeks making sure you are eating plenty of gluten in the meantime. I mean like five pieces of wheat bread daily or the gluten equivalent (10g daily).

What symptoms do you have?

I would also seek an endoscopy/biopsy. 

Edited May 27, 2024 by trents

[SMK7]

Thank you so much for your reply and info, it’s really helpful.

 
I have a lot of general symptoms, like joint pain, low iron, diarrhea/constipation/bloating for many years that I manage with daily fiber, edema/swelling, brain fog, fatigue, and nausea.

My genetic testing for one of the celiac genes ( I think it was dq2?) was positive.

[trents]

Welcome to the forum, SMK7!

It could be a false positive since your total IGA at 136 is within normal range. However, it could also mean you have celiac disease and are an IGG celiac instead of an IGA celiac. 

Yes, I would get the blood test repeated soon in several weeks making sure you are eating plenty of gluten in the meantime. I mean like five pieces of wheat bread daily or the gluten equivalent.

What symptoms do you have?

I would also seek an endoscopy/biopsy. 

1 hour ago, SMK7 said:

Thank you so much for your reply and info, it’s really helpful.

 
I have a lot of general symptoms, like joint pain, low iron, diarrhea/constipation/bloating for many years that I manage with daily fiber, edema/swelling, brain fog, fatigue, and nausea.

My genetic testing for one of the celiac genes ( I think it was dq2?) was positive.

Having one of the celiac genes establishes the potential for developing celiac disease but cannot be used per se by itself as a diagnostic criteria. About 40% of the general population have one or more of the genes associated with celiac disease but only about 1% of the general population actually devop celiac disease.

[SMK7]

Thanks so much, based on your advice I think I will definitely first ask the NP if I could repeat blood test to resolve before going to biopsy/further tests. I don’t usually eat a ton of wheat, maybe every couple of weeks, but I am currently eating gluten daily, and do notice more nausea, but it’s mild like my other symptoms.

another question- what is an IgG celiac?

[trents]

Eat wheat daily and a generous amount. The equivalent of 4-6 slices of bread made with wheat flour daily for at least three weeks leading up to the blood draw and the biopsy.

Edited May 27, 2024 by trents

[RMJ]

It certainly doesn’t hurt to repeat the blood tests, but I’m not sure why you think it might be a false positive, especially when you have symptoms.  One doesn’t have to have positives on all the antibody tests to have celiac disease. 

[SMK7]

I’m just not understanding the result—it’s not as definitive as if I had positive in the two first tests, as I understand. And then getting a biopsy and further testing isn’t easy for me as I have a lot going on with kids and family, I just don’t want to go down a rabbit hole unless I absolutely have to. The reason I did the initial test was because I was seeing a psychologist for attention issues and she studies the connection and suggested I do the blood tests. 

[trents]

The most popular blood antibody test ordered by physicians is the tTG-IGA. It is cost effective, has good sensitivity and good specificity and is the only one ordered by many physicians. Kudos to your doc for ordering a more complete celiac antibody panel. For several reasons, some who truly have celiac disease do not test positive for the tTG-IGA but other celiac antibody tests may catch them. Since it sounds like you may not have been consuming enough gluten to trigger a positive in the tTG-IGA it is possible that ramping up your gluten consumption, what we call the "gluten challenge" may trigger a positive in the tTG-IGA. On the other hand, if your retest and get negatives in all tests, you may be looking at NCGS (Non Celiac Gluten Sensitivity) for which there is no testing yet, is 10x more common than celiac disease and shares many of the same symptoms with celiac disease. Retesting antibodies may give you guidance about proceeding with an endoscopy/biopsy.

Edited May 27, 2024 by trents

[RMJ]

It would be interesting to see if your antibodies increase with increased gluten consumption.  Would it be the same laboratory running the repeat tests? The units used for the celiac antibody tests aren’t absolute, so the normal ranges may be different and one can’t always compare results from different labs/manufacturers.

[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. 

 

 

[SMK7]

Thanks for all your thoughts. I retested 5 weeks after the original test. I ate a lot of pizza, bread and wheat products these past weeks. They only retested 3 things:

TTG Ab,IgA —Less that 0.5 ( positive is above 15)

Gliadin DGP Ab IgA —219.3 (positive is above 15)

IGA—143 (normal range 87-474)

So correct me if I’m wrong, but I’m concluding that I have an immune reaction to gluten but it’s not necessarily damaging my digestive tract.

the NP seemed slightly dismissive of my symptoms, but also said that it’s unlikely I have celiac and the only way to know is with endoscopy.

Please I would love to hear your thoughts! Thanks

[trents]

6 minutes ago, SMK7 said:

So correct me if I’m wrong, but I’m concluding that I have an immune reaction to gluten but it’s not necessarily damaging my digestive tract.

the NP seemed slightly dismissive of my symptoms, but also said that it’s unlikely I have celiac and the only way to know is with endoscopy.

Please I would love to hear your thoughts! Thanks

I would not assume your conclusion about not having any damage to the intestinal track is correct. Some of your symptoms could suggest otherwise, e.g. , low iron. I agree with the NP, you should seek an endoscopy/biopsy for clarity.

[Scott Adams]

I agree and @SMK7 your next step would be an endoscopy, and even if that were to turn out negative you may still want to go gluten-free, as you may be in the early stages of celiac disease, and are definitely mounting an immune response to gluten.

Approximately 10x more people have non-celiac gluten sensitivity than have celiac disease, but there isn’t yet a test for NCGS. If your symptoms go away on a gluten-free diet it would likely signal NCGS.

 

[SMK7]

Just to follow up on this, a year later I had endoscopy, the result was mild chronic gastritis, the initial endoscopy looked normal and the biopsy was normal.

 

[Scott Adams]

I think that with the elevated antibodies found in past tests, and a negative biopsy, you are firmly in the NCGS camp. If symptoms go away on a gluten-free diet it would be confirmation that you should likely stay on the diet.

[RMJ]

Yay for the normal biopsy! Thanks for the follow up.

Were you eating gluten prior to the endoscopy?

[SMK7]

Yes, I made an effort to eat extra gluten at least 3 weeks before the endoscopy. I probably ate a some amount in the weeks before that. I had diarrhea, which resolved once I cut back after the endoscopy. So I think it would make sense to go mostly gluten free?

 

[RMJ]

Yes, it would make sense to go mostly gluten free, since it gives your troubles.

[knitty kitty]

@SMK7,

Have you had a genetic test to see if you carry any of the known genes required for Celiac Disease to develop?   

If you don't carry any known Celiac genes, then you would have Non-Celiac Gluten Sensitivity.  

Having the celiac disease genes doesn't mean one will definitely develop celiac disease. The genes need repeated exposure to gluten and an environmental trigger to turn on and start the development of celiac disease.   However, NCGS is considered a precursor of Celiac Disease in those with the genetic predisposition.  

While antibodies, like DGP IgA and DGP IgG antibodies, may be present, NCGS does not involve tTg IgA antibodies.  The tTg IgA antibodies are a definitive marker for Celiac Disease.  The tTg IgA antibodies are the antibodies that attack and damage structural components in cell membranes.  This damage results in flattened villa in the small intestines, the hallmark of Celiac Disease. The absence of a strong tTg IgA response in young adults and children may be due to an immature immune system.  

The antibodies that are present in NCGS do cause inflammation and intestinal permeability.  A constant state of inflammation raises homocysteine levels which lead to cardiovascular and kidney problems.  Intestinal permeability leads to increased food sensitivity, metabolic disorders, other autoimmune diseases, and neurodegenerative diseases.  

You would be wise to have a genetic test and go completely gluten free.  If you don't have celiac disease genes and are NCGS, going completely gluten free will lower inflammation and intestinal permeability, thus lowering risk for further health problems. 

If you do have celiac disease genes, going completely gluten free now could prevent or postpone celiac disease from developing in future.  Celiac disease is triggered by repeated exposure to gluten and an environmental stressor like infection or injury.  

Chronic gastritis can lead to nutritional deficiencies including deficiencies in B12, iron, thiamine, and Vitamin D which can result in anemia, osteoporosis and infertility.  Chronic gastritis and its accompanying inflammation can lead to further nutrient malabsorption.

You might want to discuss with your doctor and nutritionist the benefits of a genetic test and a completely gluten free diet.

References:

https://pmc.ncbi.nlm.nih.gov/articles/PMC10381837/#:~:text=The presence of TTG2 antibodies,in celiac disease patients [24].

https://pubmed.ncbi.nlm.nih.gov/38078323/#:~:text=Titers of antibodies to DGPs,celiac disease in mass screening studies.

Edited June 13 by knitty kitty
Typo correction

[SMK7]

Thanks, yes I have one of the celiac disease genes.

[SMK7]

This was the advice from the GI physician: 

"We discussed that your work-up is equivocal for celiac disease due to discordant serologies and biopsy results. As we discussed the gliadin DGP Ab IgA has a lower sensitivity (87%) and specificity (80-95%) for celiac disease compared to tissue transglutaminase Ag IgA (sensitivity of 95%, specificity of >95%, which you tested negative for). Your duodenal biopsies were normal; though in mild cases of celiac disease, affected areas can be patchy. While about 90% of individuals with celiac disease carry the HLA-DQ2 allele, many people in the general population also carry this allele without developing celiac disease.  In the context of some of your symptoms of GI upset, it's possible that you may have either irritable bowel syndrome, gluten intolerance, or a very mild case of celiac disease. As we discussed, sometimes we can attempt a high gluten diet for 6-12 weeks with a repeat EGD and biopsies. Or, you can treat this as if you had celiac disease by being gluten free and see if it helps with some of your other GI symptoms. We decided to take the second approach. In patients with celiac disease, we do monitor vitamin levels every year. We would also get a DXA scan to screen for osteoporosis. I have ordered these studies for this year; subsequent checks can be done via your primary care doctor's office."

[knitty kitty]

Welcome to the Tribe!   Take the Celiac diagnosis and run with it!

P.S.  Yes, adopting a gluten free diet is a big mental adjustment.  Many go through the five stages of grief.  Many are relieved to have a definitive diagnosis instead of being a walking medical mystery.    The forum here can help with lots of articles and years of experience to get you started on your Celiac journey.  Best wishes!

Edited June 13 by knitty kitty
Added Post Script

[SMK7]

thank you!