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Contradicting Biopsy Results, With Tissue Typing And With Blood Tests


webbydu

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webbydu Rookie

My 12 yr old daughter recently had blood test done ... Ttg 146, endomysial (IgA) antibody was postive. She recently had an endoscopy which (i will quote the Dr's letter) 'examination was normal and duodenal biopsies showed intraepitheilial lymphocytosis consistent with a diagnosis of celiac disease without other features of celiac disease'. But, he was unwilling to call it Celiac for sure without a tissue typing looking for DQ2 and DQ8 and these have come back negative.

Does she has celiac or not? What do you think?

He is going to ask his colleagues.

She does not present with diarhea or bowel problems, - but has polyarthralgia, stiffness in hands and feet, lots of itchy rashes. significant stomach pain. And has recently lost about 4-5 kgs in the last 6-7 months that she hasn't been well.

What do we ask for now? Is this significant?

Please advise.

Liz (in New Zealand).


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mushroom Proficient

You will find elsewhere on this forum that these are not the only genes associated with celiac. In Europe, especially, they recognise others. The gene experts on here will advise you further, but IMHO she is celiac, regardless of what the doctor says.

Lisa Mentor

Liz,

Welcome!

Your daughter is symptomatic, had positive blood testing and endoscopy consistent with Celiac Disease. What more would your doctor want! Her itchy rash may be Dermatitis Herpetiformis which is also consistent with Celiac.

A positive dietary response is also diagnostic. I would suggest the diet and consider your daughter diagnosed (in my opinion)

This is the best source for information. Take a walk around ;)

ravenwoodglass Mentor

I guess your doctor wants her to continue until those villi are totally destroyed. All because she doesn't have what he considers a celiac gene. Most places only look for DQ2 or DQ8 and if those are not there the response is that everything else was wrong. There are actually another 7 genes recognized in various parts of the world as being related to celiac. Just because she does not carry DQ2 or DQ8 does not mean that it nullifies all the other positive tests. You need to get her gluten free and I would also suggest doing a celiac panel on all other first degree relatives.

tarnalberry Community Regular

Those two genes cover the vast majority of - BUT NOT ALL - cases of celiac. So, you can't guarantee a rule out with a gene test either.

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    • par18
      Thanks for the reply. 
    • Scott Adams
      What you’re describing is actually very common, and unfortunately the timing of the biopsy likely explains the confusion. Yes, it is absolutely possible for the small intestine to heal enough in three months on a strict gluten-free diet to produce a normal or near-normal biopsy, especially when damage was mild to begin with. In contrast, celiac antibodies can stay elevated for many months or even years after gluten removal, so persistently high antibody levels alongside the celiac genes and clear nutrient deficiencies strongly point to celiac disease, even if you don’t feel symptoms. Many people with celiac are asymptomatic but still develop iron and vitamin deficiencies and silent intestinal damage. The lack of immediate symptoms makes it harder emotionally, but it doesn’t mean gluten isn’t harming you. Most specialists would consider this a case of celiac disease with a false-negative biopsy due to early healing rather than “something else,” and staying consistently gluten-free is what protects you long-term—even when your body doesn’t protest right away.
    • Scott Adams
      Yes, I meant if you had celiac disease but went gluten-free before screening, your results would end up false-negative. As @trents mentioned, this can also happen when a total IGA test isn't done.
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      I found at Disney springs and Disney they have specialist that when told about dietary restrictions they come and talk to you ,explain cross contamination measures tsken and work with you on choices. Its the one place I dont worry once I've explained I have celiac disease.  Thier gluten free options are awesome.
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