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- Scott Adams replied to Wamedh Taj-Aldeen's topic in Celiac Disease Pre-Diagnosis, Testing & Symptoms2Positive TTG antibody and negative EMA antibody
This is an interesting case. A positive tissue transglutaminase (tTG) antibody with a negative endomysial antibody (EMA) and normal duodenal histology can present a diagnostic challenge, especially in an asymptomatic patient. While the absence of villous atrophy and negative EMA suggest that the likelihood of active celiac disease is low at this time, such... -
- Scott Adams replied to dominiqueccms's topic in Post Diagnosis, Recovery & Treatment of Celiac Disease2
Old to diagnosis
Have you tried to start a gluten-free diet since your diagnosis in 2019? -
- trents replied to Wamedh Taj-Aldeen's topic in Celiac Disease Pre-Diagnosis, Testing & Symptoms2Positive TTG antibody and negative EMA antibody
Welcome to celiac.com, @Wamedh Taj-Aldeen! Just curious, what is your relationship to the patient? Are you the attending physician? A medical student? A consulted physician? Was a total IGA test ordered? Some physicians are under the dated and mistaken impression that such is only necessary in young children. If total IGA is low, other IGA antibody... -
- trents replied to dominiqueccms's topic in Post Diagnosis, Recovery & Treatment of Celiac Disease2
Old to diagnosis
Welcome to the forum, @dominiqueccms! Unfortunately, your story is all too common. Some older physicians are dismissive when it comes to gluten intolerance disorders and have this attitude like, "It's the latest fad disease." My advice to you is to get another doctor who has more current knowledge in this area and will take this seriously. In the meantime... -
- trents replied to Cat M's topic in Celiac Disease Pre-Diagnosis, Testing & Symptoms3
Weakly positive DGP IgA
By the way, you need to repost those numbers in your first post and add the reference ranges. Different labs use different reference ranges so the test scores by themselves aren't very helpful, especially when the values may be borderline positive. It would need to be in a new post window as the edit function times out quickly such that you can't go back...
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By Scott Adams · Posted
This is an interesting case. A positive tissue transglutaminase (tTG) antibody with a negative endomysial antibody (EMA) and normal duodenal histology can present a diagnostic challenge, especially in an asymptomatic patient. While the absence of villous atrophy and negative EMA suggest that the likelihood of active celiac disease is low at this time, such serological discordance may still warrant monitoring. Some individuals may be in the early stages of celiac disease, often referred to as potential celiac disease, particularly if they carry the HLA-DQ2 or DQ8 haplotypes. HLA typing can be quite helpful in this situation; a negative result would virtually rule out celiac disease, whereas a positive result may justify periodic follow-up to monitor for evolving disease. The risk of progression to overt celiac disease is not well defined but appears to be higher in children, those with a family history, or those with autoimmune conditions. In this case, routine follow-up including repeat serology and consideration of symptoms or new risk factors over time would be a reasonable and cautious approach. -
By Scott Adams · Posted
Have you tried to start a gluten-free diet since your diagnosis in 2019? -
Welcome to celiac.com, @Wamedh Taj-Aldeen! Just curious, what is your relationship to the patient? Are you the attending physician? A medical student? A consulted physician? Was a total IGA test ordered? Some physicians are under the dated and mistaken impression that such is only necessary in young children. If total IGA is low, other IGA antibody numbers will be artificially depressed. By the way, it is not unusual to have a positive TTG-IGA and a negative EMA. Are the TTG-IGA numbers borderline high or unequivocally high? There are other diseases, medical conditions, medications and even foods (cow's milk protein) that can cause elevated TTG-IGA numbers besides celiac disease but when this is the case, the numbers are usually not dramatically elevated. It can also be the case that villous damage was patchy and affected areas were missed during the biopsy. Or, onset of celiac disease was very recent and villous atrophy has not yet progressed to the point of detectability. We also have occasional anecdotal reports in this online community of positive antibody testing with negative histology, as you report. But we also know that gluten intolerance can manifest itself apart from enteropathy. It can damage other organ systems. Many celiacs are of the "silent" type, meaning there is an absence or a relative absence of symptoms until the disease has become advanced and there is significant damage to the villous lining or other organ systems. But to answer your questions: 1. I would definitely pursue a routine follow-up and recheck of the antibodies. And, I would order a complete celiac panel including total IGA and IGG stuff in say, six months. Sooner if symptoms manifest. 2. It is impossible to say what is the risk of the future development of over celiac disease. I refer you back to my #1 above concerning rechecking. 3. I would definitely pursue HLA DQ2/DQ8 typing as it can be used as a rule out for celiac disease, though not quite with 100% dependability. I hope my thoughts prove helpful to you.
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Welcome to the forum, @dominiqueccms! Unfortunately, your story is all too common. Some older physicians are dismissive when it comes to gluten intolerance disorders and have this attitude like, "It's the latest fad disease." My advice to you is to get another doctor who has more current knowledge in this area and will take this seriously. In the meantime, this might be helpful: In six months to a year you would do well to get your antibody numbers rechecked to see if you are succeeding in your efforts to eat gluten free. Do you have the numbers from the original testing?
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By the way, you need to repost those numbers in your first post and add the reference ranges. Different labs use different reference ranges so the test scores by themselves aren't very helpful, especially when the values may be borderline positive. It would need to be in a new post window as the edit function times out quickly such that you can't go back and make changes to the original. What symptoms do you have? What has led you to investigate the possibility of having celiac disease?
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