Ttg

[hannahsue01]

My 4 year old daughter went saw a GI doctor about a month ago. Out of all the tests they ran on her the only test that seems to relate to celiac is one labled TTG and it says 2 UNITS. Is this the only one and since this one came up fine does she need additional testing. My daughter was very constipated for over six months....they put her on a stool softener and now she is doing ok on that. She complains allot that her tummy hurts....she is moody.....eats like a pig.....sometimes complains of headaches.....chokes occasionally on usually liquid. She has been diagnosed with failure to thrive.....she is in the 9% on wieght and 25% on hight and has fallen drasticly of her own curve. I am worried about her growth and donno what to do.....they mentioned maybe doing a scope but donno if they will or not for sure....she goes back at the end of October. Everyone seems to think we are starving her because of how skinny she is but she eats as much as her father and I do and still sneaks food in between.....I've been keeping a log on what she eats. There is a very strong family history of celiac.

[KaitiUSA]

That is one of the most specific tests for celiac but the whole panel needs to be run. You see if she is IgA deficient that test can show up normal when it may really be high. So the total serum IgA will rule out IgA defienciency. A gene test is never a bad thing either since most celiacs have the HLA-DQ2 or HLA-DQ8 gene. If she has symptoms of celiac I would noot ignore it. The body knows more than a test can tell you.

[Suzie-GFfamily]

My understanding is that the tTG may sometimes be falsely negative. It has been reported that the tTG can sometimes be falsely negative in children less than 5 yrs and it can also be falsely negative in people who have selective IgA deficiency.

There is a discussion of the diagnosis of celiac disease in children on the following website from the UK:

Open Original Shared Link

Did they do a total serum IgA at the same time as the tTG test to see if her IgA levels are normal or not?

If her IgA levels were low, than you could get a negative tTG result. The standard tTG test will measure the levels of tissue transglutaminase IgA antibodies. There is a separate tTG test that can measure IgG antibodies instead for people with IgA deficiency.

Some GI's will not even bother with the tTG but will just do an endoscopy/biopsy if there is a strong suspicion of celiac- eg. if someone has symptoms and a family history of celiac disease. There is an article in a peroidical called the Autralian Precriber in 2001 which discusses this:

Open Original Shared Link

However, in the US and Canada there is a lot more emphasis on the tTG test and it is commonly being used to diagnose the disease as well as a screening tool. Some GI's are not willing to perform a endoscopy if the tTG is negative, even if someone has symptoms that suggest celiac.

It sounds like celiac is a strong possibility in your daughter's case. And if she doesn't have celiac disease, than it sounds like something is definitely wrong and needs attention.

If you strongly suspect celiac disease- than tell her dr's that this is how you feel. The blood test is a screening tool- but that doesn't mean you have to rule out celiac if the tTG is negative. The genetic test that someone else mentioned could be useful if you'd like some more information before proceeding to a biopsy. If they do the HLA typing and she doesn't have DQ2 or DQ8 than you can pretty much rule out celiac (with about 99% certainty). The genetic test won't tell you that she has celiac disease, but it could be another piece of evidence to add to the other suspicions - ie symptoms and family history.

Good luck in finding the cause of your daughter's discomfort.

Suzie

London, ON Canada

[mle-ii]

My feeling is that an IgA deficiency should always go along with Ttg. Given my recent research I understand the use of Ttg as the main testing. Though along with false negatives this would also have false positives as well.