Can Medications Cause False Negatives?

[sick-of-being-sick]

I'm new here; I have lots of autoimmune diseases, including autoimmune hepatitis. I'm taking azathioprine and prednisone for the AIH. I have gastrointestinal problems (diarrhea mostly) and have been losing weight for the last 6 months.

My doctor recently tested me for celiac disease including DNA typing. All of the blood tests were negative except that I do have a celiac gene (DQ8). Now she wants to do a biopsy, but I don't know if it's worth it.

Has anyone here been tested for celiac disease while taking drugs to suppress the immune system? Has anyone had an intestinal biopsy done while taking meds like prednisone? Do prednisone or azathioprine cause false negatives in tests for celiac disease?

rissa

[Jestgar]

Rissa, I hope you get an answer from someone with experience, but it makes sense that your antibodies could be suppressed by steroids. Your intestine, however, would not look better. This doesn't mean that your tests would be positive, it just means they won't be negative because of the prednisone.

[happygirl]

Welcome to the board, Rissa.

Given your symptoms, your positive genetic test, and your other health concerns, an endoscopy may be of benefit. Not only to look for Celiac - but to look for other issues.

I can't say for certain that these meds will or won't affect it - but I will say that in my experience and reading of Celiac literature, I have never seen it mentioned when discussing the biopsy.

I would talk to your doctor about it, also.

[sick-of-being-sick]

Rissa, I hope you get an answer from someone with experience, but it makes sense that your antibodies could be suppressed by steroids. Your intestine, however, would not look better. This doesn't mean that your tests would be positive, it just means they won't be negative because of the prednisone.

Thanks for the reply, Jestgar. I have been worried about the biopsy results being affected by the prednisone. I just don't want to go through that if there will be nothing to see. So maybe I've been looking for some excuse to cancel the procedure and go gluten-free right away to see if it makes me feel better. As it is, the doctor wants me to stay on gluten for a few more weeks until after the biopsy.

Oh well....I suppose I can wait a little longer,

rissa

[Jestgar]

Oh well....I suppose I can wait a little longer,

If it's already set up, and you can wait it out, you may as well wait. At least it'll be one more thing you know about yourself.

[sick-of-being-sick]

Welcome to the board, Rissa.

Given your symptoms, your positive genetic test, and your other health concerns, an endoscopy may be of benefit. Not only to look for Celiac - but to look for other issues.

I can't say for certain that these meds will or won't affect it - but I will say that in my experience and reading of Celiac literature, I have never seen it mentioned.

I would talk to your doctor about it, also.

Thank for the welcome and helpful reply!

I did mention my concerns to my doctor but she insists that she wants to do a biopsy regardless of my medications. Hopefully, if I really do have celiac disease, there will be some evidence to be found. Not that I'm looking for one more diagnosis. I think that I have more than enough autoimmune diseases already!

rissa

[happygirl]

To maximize the endoscopy, talk to your doctor beforehand and make sure they are taking a sufficient amount of samples (about 4-6), as Celiac can be a patchy disease. (references: Open Original Shared Link and Open Original Shared Link

Again, I'm not sure if the meds you are on would affect it. You may want to ask your doctor about the use of steriods to treat refractory celiac sprue (some Celiac patients' intestines don't respond to the diet, and it is called refractory celiac). That's the only reference I can recall re: celiac and steriods, so I don't know how it would affect a potential Celiac on a gluten containing diet.

[mslee]

I'm new here; I have lots of autoimmune diseases, including autoimmune hepatitis. I'm taking azathioprine and prednisone for the AIH. I have gastrointestinal problems (diarrhea mostly) and have been losing weight for the last 6 months.

My doctor recently tested me for celiac disease including DNA typing. All of the blood tests were negative except that I do have a celiac gene (DQ8). Now she wants to do a biopsy, but I don't know if it's worth it.

Has anyone here been tested for celiac disease while taking drugs to suppress the immune system? Has anyone had an intestinal biopsy done while taking meds like prednisone? Do prednisone or azathioprine cause false negatives in tests for celiac disease?

rissa

Hey There,

Welcome!

I am fairly new here too, I got an definite dx of Celiac in July...See below I have other immune issues too.

I am not sure about the effects of the meds your on, on the celiac test but I can tell you the results from going gluten free are AMAZING... I feel more human than I have my whole life, more energy, strength, and mind clarity. I am so happy for the Dx! If they had not found it things could have gotten really bad, my condition was headed downhill fast.

Besides the celiac the colonoscopy/endoscopy found colitis. I would suggest having it done, it's not much fun but catching something serious early is worth it.

I was raised in Southern California, and am waiting up a follow apt for a liver biopsy for suspected autoimmune hepatitis. If you ever have any questions or want to talk feel free to message me.

Hang in there! ... this diet may be very beneficial for you!

~A.Lee

[nora-n]

Prednisone will cause villie to grow back even while eating gluten, and it says so in anarticle here on celiac.com. There was a discussion last week at the delphi forum, and Bobbie never got a defiine diagnosis because she was on prednisone. She is one of the moderators there.

Here in Europe we always get the endoscopy done, and it is to rule out oterh severe things, and to have something to compare with later.

All the things you mention, are connected to celiac oand will probably get better on a gluten-freee diet.

nora

[JNBunnie1]

Prednisone will cause villie to grow back even while eating gluten, and it says so in anarticle here on celiac.com. There was a discussion last week at the delphi forum, and Bobbie never got a defiine diagnosis because she was on prednisone. She is one of the moderators there.

Here in Europe we always get the endoscopy done, and it is to rule out oterh severe things, and to have something to compare with later.

All the things you mention, are connected to celiac oand will probably get better on a gluten-freee diet.

nora

Could you post a link to the article? Thanks.

[Jestgar]

The research it cites is 25 years old. I only found one recent article which combined prednisone with an additional drug to treat refractory sprue. Some healing of the villi was seen, but the people were on a gluten-free diet.

[sick-of-being-sick]

Hey There,

Welcome!

I am fairly new here too, I got an definite dx of Celiac in July...See below I have other immune issues too.

I am not sure about the effects of the meds your on, on the celiac test but I can tell you the results from going gluten free are AMAZING... I feel more human than I have my whole life, more energy, strength, and mind clarity. I am so happy for the Dx! If they had not found it things could have gotten really bad, my condition was headed downhill fast.

Besides the celiac the colonoscopy/endoscopy found colitis. I would suggest having it done, it's not much fun but catching something serious early is worth it.

I was raised in Southern California, and am waiting up a follow apt for a liver biopsy for suspected autoimmune hepatitis. If you ever have any questions or want to talk feel free to message me.

Hang in there! ... this diet may be very beneficial for you!

~A.Lee

Thanks!

I'm glad that the gluten-free diet is making such a difference for you. That's the kind of story that gives me some hope for myself!

My doctor did mention microscopic colitis as one of the things she'd be looking for during the procedures. I'm planning to go ahead and get them done....whatever the outcome. Also, good luck with your biopsy results! My liver damage from AIH is at stage 2, which is still reversible.

Take care,

rissa

[sick-of-being-sick]

The research it cites is 25 years old. I only found one recent article which combined prednisone with an additional drug to treat refractory sprue. Some healing of the villi was seen, but the people were on a gluten-free diet.

Thanks Nora and Jestgar.....I was going to ask for the reference but JNBunnie1 beat me to it.

Is the original citation about prednisone causing villi to regenerate in that book edited by Davison, Humphrey, Liversedge et al. Multiple Sclerosis Research, Elsevier Scientific Publishing New York, 1975?

rissa

[sick-of-being-sick]

To maximize the endoscopy, talk to your doctor beforehand and make sure they are taking a sufficient amount of samples (about 4-6), as Celiac can be a patchy disease. (references: Open Original Shared Link and Open Original Shared Link

Again, I'm not sure if the meds you are on would affect it. You may want to ask your doctor about the use of steriods to treat refractory celiac sprue (some Celiac patients' intestines don't respond to the diet, and it is called refractory celiac). That's the only reference I can recall re: celiac and steriods, so I don't know how it would affect a potential Celiac on a gluten containing diet.

Thanks, happygirl!

I knew I forgot to ask the doctor about something important, like how many different spots she typically biopsies.

So many details to remember....and my brain is not functioning well these days.

rissa

[nora-n]

Here is the article that mentions that prednisone will cause the villi ti grow back:

https://www.celiac.com/articles/124/1/Multi...ease/Page1.html look towards the end. Don Wiss has written about celiac for years. He has some celiac websites too, and is on some forums.

And, Bobbie at the delphi forum had that happen to her, just go over and ask her. I think I remember she is a M.D. , and a moderator there.

[hawaiimama]

Ok, now I'm curious, what about low dose steriods like cortef?

[Jestgar]

Open Original Shared Link

no dose listed in abstract.

Open Original Shared Link

Also used in treatment of refractory sprue. No comment on the villi (or dosage).

Not much info. I don't think it's thought to heal the villi, only to decrease the inflammation.

[Fiddle-Faddle]

YES!

I had been on prednisone AND gluten-free when bloodwork and a skin biopsy (looking for DH) were taken. The biopsy was negative, and MOST of the bloodwork was also negative, but my IgG was through the roof. That, combined with how much better I felt gluten-free (I, too, had several autoimmune issues), was enough to convince me not to touch gluten ever again!

[mslee]

Thanks!

I'm glad that the gluten-free diet is making such a difference for you. That's the kind of story that gives me some hope for myself!

My doctor did mention microscopic colitis as one of the things she'd be looking for during the procedures. I'm planning to go ahead and get them done....whatever the outcome. Also, good luck with your biopsy results! My liver damage from AIH is at stage 2, which is still reversible.

Take care,

rissa

Thanks!

One thing to keep in mind this trial and error period can be very tricky, I will feel sooo good for a couple days and then eat something with some mystery ingredient in it that makes me sick for a day or 2. Keeping a diet diary is very helpful. I saw an allergist Tues and have testing tomorrow, probably wont find anything because these are probably intolerances rather than allergies but I figured it was worth a try.

Eating very simple foods is your best bet...I have always been an adventurous eater so I am having a hard time sticking to bland and boring.... But would not touch gluten with a 10 ft pole!!!

My GI said it was odd I had both microscopic colitis and ulcerative colitis, my liver has "minimal" inflammation so I hope it will heal being off gluten. Find out Fri. with my follow up apt.

This info about prednisone is very interesting! the stuff still scares me!

Good Luck!!!

Hang in there!!!

[susanm]

I have Addison's disease, so I take hydrocortisone. I asked my doctor if that would affect the biopsy. He told me that in Addison's, I only take enough to live, so it shouldn't affect it (although I'm not so sure about that). Hearing that, it makes me think that taking more steroid would affect the biopsy. I had the endoscopy Monday, and I'm waiting for the results.

[russtay1]

I have Addison's Disease and have long suspected a gluten allergy. All my celiac tests were negative.

This article (see below) interests me. It is very possible that even the replacement doses of steroids we take for adrenal insufficiency could cause false negatives in celiac testing.

I worry more about WHY I have so many autoimmune disorders. I have four. I suspect a gluten or other food allergy as the cause.

I think the best thing to do, if test results are negative, is avoid gluten and see how you feel.

Anne

Open Original Shared Link

The last few paragraphs are the most interesting. I'll paste them here:

"There have been reports in the literature of an unmasking of coeliac disease in patients discontinuing chronic steroid therapy and steroids have a well-recognized therapeutic role in the management of refractory coeliac disease. In a treated Addison

[nora-n]

wow interesting.

I was on suppplemental steriods before testing too.

I do not have a diagnosis for partial adrenal insufficiency but I have had to get hycrocoertisone or prednisolone off the net.

Interestingly, the need for supplementing has almost vanished after going gluten-free. I just need them sometimes, or for a period.

I have hashimotos too, and some endometriosis (autoimmune too) and it seems like there is some inflammation of some sort in the brain since TSH and ft3 gets so low.

I have read several other abstracts and articles on adrenals , addison and gluten before. But this one is about villi getting normal on just supplemental doses.