5 year old - awaiting biopsy results

[SarahWarner]

I guess I don’t really have a question but after 3 years of symptoms and being sent away from dr after dr and multiple hospital visit we found a paediatrician who listened and done iron studies which come back iron deficient without anemia which prompted her to test for celiac which come back as below

IgA <0.06g/L

deamidated gliadin IgG 244U/mL 

TTg IgA <1U/mL

Paediatrician said this was consistent with celiac disease but gastroenterologist said that it is likely not celiacs disease but agree to do biopsies anyways. After upper endoscopy the doctor explained that she has visible inflammation of the small intestine which was consistent with celiacs disease. I’m just worried the result for biopsy will come back negative and we will be back to square one in finding out the issue and she now has moderate iron deficiency anemia which was found on her most recent blood test which is not good for developing brain. Does this look good for a celiac diagnosis? 

 

 

[trents]

Welcome to the forum, @SarahWarner!

We cannot tell much from the numbers you supplied unless you also supply the reference ranges for negative vs. positive. Different labs concoct the tests differently and used different reference ranges. What we can say from what you have given us is that her total IGA is low which can cause a false negative in the tTG-IGA. The DGP-IGG at 244U/mL looks to be high but without the reference range we can't say for sure. Young children who have celiac disease often do not respond with a positive on the tTG-IGA because their immune systems are immature so that is the value of running the total IGA and the alternate antibody test, the DGP-IGG. 

Edited June 5, 2024 by trents

[RMJ]

Sounds like you found a good pediatrician!  I hope you get a clear cut answer from the biopsies.  Please let us know the results.

If biopsies are negative, luckily you don’t need a doctor’s permission or prescription to try a gluten free diet. Just don’t start until you have all the celiac results - going gluten free too early can lead to false negatives on the testing.  If her symptoms and blood test results improve on a gluten free diet that’s another sign that gluten is a problem.

[SarahWarner]

Thankyou @trents and @RMJ! We have our biopsy results back and they look to be consistent with diagnosis of celiac disease from what I can see. I have attached the findings below 😊

MICROSCOPIC :
A. The sections show squamous mucosa with no significant abnormality. There is no spongiosis, basal zone expansion, lamina propria papillae elongation, or parakeratosis. Inflammatory cells are not increased. Eosinophils are not identified. Asmall amount of mildly crushed sub-epithelial stroma is present. No fungal elements are identified.
B. The sections show acid secreting and non-acid secreting gastric mucosa. There is a patchy mild increase in plasma cells and lymphocytes within the lamina propria consistent with mild non-specific chronic inflammation. There is no active inflammation or lymphoid follicle formation. No Helicobacter organisms are identified on H&E or Giemsa. No granulomas or intestinal metaplasia are seen.
C. The biopsies of duodenal mucosa show increased intra-epithelial lymphocytes and severe villous blunting with crypt elongation ni well-oriented biopsies. The lamina propria is expanded by increased numbers of plasma cells ni addition to scattered lymphocytes, eosinophils and neutrophils. There are scattered areas of moderate intrepithelial neutrophil infiltration, mainly at the mucosal surface. The subepithelial collagen is not thickened. No granulomas or Giardia are identified.

[trents]

"The biopsies of duodenal mucosa show increased intra-epithelial lymphocytes and severe villous blunting"

I agree with you conclusion, Sarah. Time to put her on the gluten free diet in earnest.