Appointment With Gi On Monday

[Wthrman13]

As I stated in my earlier thread, my brother was diagnosed with Celiac Disease a few weeks ago, and he recently had a biopsy, the results of which are still pending. I don't know what his numbers were on the blood test. I went and had a blood test a couple weeks ago, and I'll repost the results here, since I am still puzzled by something. The doctor was also not sure about my celiac disease status, so he referred me to a GI, an appointment with which I have on Monday (no biopsies or anything, just an introductory appointment).

Thanks to all who responded in that other thread, but since I though of a new question, I thought I would ask again here. Well anyway, first, here are my blood test results again:

Antigliadin Abs, IgA: 2 U/mL

Antigliadin Abs, IgG: 41 U/mL

tTG IgA: 1

tTG IgG: 1

Endomysial Antibody IgA: Negative (I assume this is just the interpretation of the above two tTG tests)

Immunoglobin A, Qn, Serum: 52

After doing some more research, it seems that even if I have an IgA deficiency, as suggested by the above results, that the tTG IgG test would still likely be positive if I have celiac disease. Or is it only the tTG IgA antibody that is specific to celiac disease? Basically, what I'm asking from anyone who is more knowledgeable than I am, is what is the difference between the two tTG antibody types regarding their specificity for celiac disease? I know that the Antigliadin antibodies are not as specific, and there can be false positives, especially with the IgG antibody. Yet, as Doll stated in the other thread, the fact that I have such an elevated result for that antibody, and my family history, is very suggestive. That's what confuses me a bit about the tTG IgG result, which is very low. And, if it turns out I don't have celiac disease, what other conditions could the IgG result be heralding, if any? Could it be some sort of non-Celiac gluten intolerance?

These are all questions I'm going to ask the GI when I meet him, but I thought some folks on this board might be able to clarify some of them for me in advance. Thanks again for any help!

[happygirl]

I looked up your reference ranges, and from your previous post:

"Well, the test shows normal ranges for each of the different antibody tests. For the IgG test, which I showed as 41, the normal range is 0-9. For the Immunoglobin A, Qn, Serum (perhaps short for quantity of Immunglobin A in the serum?), the normal range shows on my sheet as 70-400, whereas my test result is 52."

And the AntiEndomysial Antibody is not the same thing as the tTG. the EMA and the tTG are the two main/most specific tests for celiac, that are usually run as EMA IgA and tTG IgA....you were negative on both. The full test panel includes:

Anti-gliadin antibodies (AGA) both IgA and IgG

Anti-endomysial antibodies (EMA) - IgA

Anti-tissue transglutaminase antibodies (tTG) - IgA

Total IgA level.

So, you were negative on all the IgA ones, which makes sense....you can't theoretically test positive for something when you aren't making it (IgA).

There are a couple ways to interpret it....

1. You don't have Celiac, but have a non-Celiac gluten intolerance, as indicated by the elevated AGA IgG. (Any food, unrelated to Celiac, can mount an IgG response; so gluten can be "true" Celiac or a gluten intolerance)

2. You do have Celiac, but the damage is not severe enough yet for it to show up on the tTG IgG, plus you don't have the benefit of the more sensitive tests being accurate.

3. People can have raging cases of Celiac with normal bloodwork but a positive biopsy (i.e., they have Celiac).

4. You don't have Celiac or non-gluten sensitivity.

It may be worth it to 1. consider a biopsy and 2. consider DNA testing (HLA DQ2 or HLA DQ8) to know if you have one of the two main genes that predispose to Celiac.

What tests were your brother positive on?

[Wthrman13]

And the AntiEndomysial Antibody is not the same thing as the tTG. the EMA and the tTG are the two main/most specific tests for celiac, that are usually run as EMA IgA and tTG IgA....you were negative on both.

Yeah, I realized that after the original post. I didn't know at the time that the tTG and the EMA were two different things.

1. You don't have Celiac, but have a non-Celiac gluten intolerance, as indicated by the elevated AGA IgG. (Any food, unrelated to Celiac, can mount an IgG response; so gluten can be "true" Celiac or a gluten intolerance)

Interesting. I'm still a little confused though. So are you saying that any food, regardless of gluten content, can raise antigliadin IgG? I thought that that specific antibody targeted gliadin molecules, which are broken down or otherwise related to gluten.

It may be worth it to 1. consider a biopsy and 2. consider DNA testing (HLA DQ2 or HLA DQ8) to know if you have one of the two main genes that predispose to Celiac.

What tests were your brother positive on?

Yeah, these are things I was planning on talking to the doctor about. I don't know which tests my brother was positive on, but I want to try to find out if I can (not sure if he got a copy of his blood test results or not).

[happygirl]

Sorry about the confusion on that...I worded it wrong

Any food can mount an IgG ("delayed allergy", "sensitivity", or "intolerance" are commonly used). For gluten, its an anti-gliadin IgG. For dairy, its an anti-casein IgG. Etc.

Just like any food can mount a "true" allergic response which is IgE mediated, intolerances are IgG mediated. Hope that clarifies.

[Wthrman13]

Yes, that makes sense now. Thanks for the clarification!

[ravenwoodglass]

One additional note to add to the great posts you have already gotten. If you do decide to do the gene tests and it shows that you are 'just' gluten intolerant you will still need to avoid gluten just as diligently as someone who has the 'celiac' gene. The damage that is done to the body with gluten intolerance can be just as serious as 'true' celiac. I am sooooo glad that I did not have gene tests when I was first diagnosed because my ex-GI is of the opinion that those without the celiac gene don't need to be as strict, so not the case. Knowing what I do now the gene test was more curiousity, but I am glad I had it because it puts me in a good position to tell folks that intolerance can be just as life threatening and dibilitating as true genetic defined celiac.

[Wthrman13]

Again, thanks for all the responses, and your point about the gluten intolerance vs. celiac is well taken, raven.

I also don't want to paper over my brother's problems during this time, and I'm trying to be very supportive of him. His symptoms leading up to his celiac disease diagnosis were, from what I could tell, more severe than anything I've had (in fact, him going to the ER for severe gas pains is what led to his diagnosis in the first place). Earlier this year he went to the doctor after having some sort of strange mental attack in which he became very confused and disoriented. From what he told me over the phone the other day, the doctor which recently diagnosed his celiac disease went back and looked over his records from that previous incident and claimed that he didn't know how the doctors at that time didn't suspect a digestive system problem in the first place!

I do recall, now, an incident several years ago where I actually went to the doctor on short notice for severe localized gas pain (at the time they thought it might be appendicitis, but the blood test was negative). I haven't had anything nearly that severe since then, but still struggle with it.

The doctor's appointment is bright and early tomorrow. We'll see what he has to say!

[Wthrman13]

Well, I went to see the gastroentorologist today, and I have mixed feelings about the visit.

First, I could tell he was busy, and he seemed a little rushed with me. When asking about the blood tests, he immediately said that lots of people have elevated IgG levels and aren't sick, and that the blood tests were just a screening tool anyway, and that the only way to tell for sure was with the small intestine biopsies. When asking about the low serum IgA, he seemed to think that the blood test just caught me at a low point, and that if I really did have such a deficiency, that I would be sick as a dog all the time. In short, he didn't seem to be the kind of doctor who took the blood tests very seriously, and rather seemed to be of the type that considered the biopsy to be the "gold standard". I did ask him about possible gluten sensitivity apart from Celiac, and he immediately replied that that was what Celiac was (i.e. he was equating gluten sensitivity to celiac disease, or at least seemed to be).

On the other hand, he did seem to take my swallowing problems seriously (which he thinks might be as a result of acid reflux, even if I don't seem to have it chronically), as well as the need to have a celiac disease biopsy, and I'm scheduled for Thursday for the endoscopy for both conditions.

In short, I really wish I could have had more time to discuss the blood test results with him. I'm not one to argue easily with a specialist, mostly because I know how it feels to have gone through many years of college and received degrees in an area, only to have someone come up to you and claim they know more than you or that you are wrong about something after reading a few articles on the internet. Don't get me wrong, I know that doctors can be wrong, and that he could be wrong about the blood test.

The bottom line is, I'm going in for a biopsy on Thursday, and regardless of what the results of that are, I'm still going to try the gluten-free diet at some point in the very near future. I haven't changed my mind on that score, and I don't need a doctor to tell me if I do or do not feel better on such a diet!