Bloodwork Help for my Teen

[Sarah Marie]

Hello!

I would appreciate help understanding my 17 year old daughter’s celiac panel.  Symptoms are general stomach discomfort, daily headaches (for years), fatigue. My husband is in process of being diagnosed as well. 

test results:

Demidiated Gliadin Abs, IgA - negative 

Demediated Gliadin Abs, IgG - negative 

tTG IGA - negative 

endometrial antibody IgA - negative 

tTG- igG - weak positive

Immunoglobulin A, Qn, serum - *low* 72 (range is 87-352)

vitamin D also very *low* at 21 (range 30-100)

From what I’ve read the combination of deficiencies in vit d and immunoglobulin A plus weak positive tTG-IgG can indicate Celiac disease.  Thoughts? 

[Scott Adams]

Your daughter's results, along with her symptoms and family history, certainly suggest further investigation for celiac disease is warranted. The low total IgA can explain why some IgA-based tests, like tTG-IgA, are negative, as there's simply not enough IgA in her system for reliable results. The weak positive tTG-IgG is notable, especially with her symptoms and the vitamin D deficiency, which is common in celiac disease due to malabsorption.

I’d recommend discussing these results with her doctor or a gastroenterologist. They may suggest an endoscopy with biopsy for a definitive diagnosis or explore other potential causes for her symptoms. Meanwhile, keeping a food and symptom diary can help track patterns until a formal diagnosis is made.

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.

 

 

[Sarah Marie]

Thanks so much for your thorough reply! I was able to schedule with the local pediatric gastroenterologist who specializes in celiac but we have to wait 3 months to see her. 

[Scott Adams]

Since it is such a long time away, you may want to have her go gluten-free for 2 months and see how she responds to the diet. If her symptoms go away, then that would be another indicator that she has celiac disease. Discuss this approach with her doctor, and if they want her to do an endoscopy, then she will need to consume lots of gluten--several slices of wheat bread's worth per day, at least two weeks prior to the procedure.

[Sarah Marie]

Is it worth it to remove gluten before they potentially do an endoscopy & biopsy? I thought I read it’s best to be eating gluten for 3 months prior to it. So hoping they have a cancellation and call us in sooner. 

[knitty kitty]

I agree, @Sarah Marie, it's best to keep eating gluten and get on the doctor's cancellation list.  Some people have extreme symptoms when reintroducing gluten after a brief abstinence.  Be sure she consumes six slices of bread or gluten-y equivalent a day in the two weeks prior to the endoscopy.  There are different amounts of gluten in different products.  Chewy pizza crust and artisan breads have more gluten than cookies and cakes.

Keep us posted on your progress!

[Scott Adams]

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;

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