Got My Enterolab Results Today

[danaf617]

Hey everyone!

A little background: I got sick and my symptoms began in December. Gastro ran celiac panel at my request - negative. Colonoscopy was normal (but had 2 polyps removed) and showed no signs of Crohn's, colitis, etc. Doctor dx'ed me with IBS-PI and prescribed Librax.

I've been miserable daily for 6 months.

For my first post with complete symptoms see here:

Anyway, here are my results:

Fecal Anti-gliadin IgA 20 Units (Normal Range is less than 10 Units)

Fecal Anti-tissue Transglutaminase IgA 9 Units (Normal Range is less than 10 Units)

Quantitative Microscopic Fecal Fat Score Less than 300 Units (Normal Range is less than 300 Units)

Fecal Anti-casein (cow’s milk) IgA 7 Units (Normal Range is less than 10 Units)

HLA-DQB1 Molecular analysis, Allele 1 0301

HLA-DQB1 Molecular analysis, Allele 2 0602

Serologic equivalent: HLA-DQ 3,1 (Subtype 7,6)

Interpretation of Fecal Anti-gliadin IgA: Intestinal antigliadin IgA antibody was elevated, indicating that you have active dietary gluten sensitivity. For optimal health, resolution of symptoms (if you have them), and prevention of small intestinal damage and malnutrition, osteoporosis, and damage to other tissues (like nerves, brain, joints, muscles, thyroid, pancreas, other glands, skin, liver, spleen, among others), it is recommended that you follow a strict and permanent gluten free diet. As gluten sensitivity is a genetic syndrome, you may want to have your relatives screened as well.

Interpretation of Fecal Anti-tissue Transglutaminase IgA: The level of intestinal IgA antibodies to the human enzyme tissue transglutaminase was below the upper limit of normal, and hence, there is no evidence of a gluten-induced autoimmune reaction.

Interpretation of Quantitative Microscopic Fecal Fat Score: Provided that dietary fat is being ingested, a fecal fat score less than 300 indicates there is no malabsorbed dietary fat in stool indicating that digestion and absorption of nutrients is currently normal.

Interpretation of Fecal Anti-casein (cow’s milk) IgA: Levels of fecal IgA antibody to a food antigen greater than or equal to 10 are indicative of an immune reaction, and hence immunologic “sensitivity” to that food. For any elevated fecal antibody level, it is recommended to remove that food from your diet. Values less than 10 indicate there currently is minimal or no reaction to that food and hence, no direct evidence of food sensitivity to that specific food. However, because 1 in 500 people cannot make IgA at all, and rarely, some people can still have clinically significant reactions to a food antigen despite the lack of a significant antibody reaction (because the reactions primarily involve T cells), if you have an immune syndrome or symptoms associated with food sensitivity, it is recommended that you try a strict removal of suspect foods from your diet for up to 12 months despite a negative test.

Interpretation Of HLA-DQ Testing: Although you do not possess the main HLA-DQB1 genes predisposing to celiac sprue (HLA-DQB1*0201 or HLA-DQB1*0302), HLA gene analysis reveals that you have two copies of a gene that predisposes to gluten sensitivity (any DQ1, DQ2 not by HLA-DQB1*0201, or DQ3 not by HLA-DQB1*0302). Having two copies of a gluten sensitive gene means that each of your parents and all of your children (if you have them) will possess at least one copy of the gene. Two copies also means there is an even stronger predisposition to gluten sensitivity than having one gene and the resultant immunologic gluten sensitivity may be more severe.

What do you think?

Based on this and how I've been feeling, I am ready to give up gluten for good, no question. Is that a crazy, rash decision?

I have a follow-up with the gastro on Thursday and planned to bring these results. Should I ask for a biospy? Should I accept or refuse if he suggests it? To be honest, I don't want to have it done but will if that's the best thing to do.

Should I wean off of the Librax or stay on until I've been on the diet a while?

And do these results mean that I am NOT celiac, but am non-celiac gluten sensitive/intolerant?

Any advice or recommendation you can give me will be very appreciated!

[GlutenFreeManna]

Hi, I don't know a lot about the tests, but I know Enterolab DOES NOT diagnose Celiac. They will only tell you if you are gluten sensitive. You should do all the testing you want done while you are still consuming gluten. Once you go on the diet the results of any tests will be inconclusive (most likely false negative). So if you want to find out if you test positive for celiac, get the biopsy done. If it doesn't matter to you to have that test result, then you should go right on the diet and don't look back. Just look forward to feeling better.

[Skylark]

At this point, you have gotten plenty of medical care and ruled out the inflammatory bowel conditions. Has your doctor also ruled out SIBO (small intestinal bacterial overgrowth)?

With all the negative celiac tests and your genetics, you are not likely to have a positive biopsy. I doubt your doctor will be inclined to put you through it. You can still push for one if you are the sort of person who wants to explore all diagnostic avenues, but remember you don't have to have a positive biopsy to get very, very sick from eating gluten if you're sensitive to it.

As far as giving up gluten for good, I'm not sure why you would do that. Enterolab results are not not diagnostic, even for gluten intolerance. You should definitely try the diet for a few months and see if it helps. Then make your decision based on how you feel.

[danaf617]

Has your doctor also ruled out SIBO (small intestinal bacterial overgrowth)?

I don't think so. That's a stool test, right?

I'm sure I can ask for that this week when I go.

[danaf617]

Anybody else?

[nora-n]

The 0301 means DQ7, and many DQ7 have the 05* alpha chain, menaing they have half a DQ2.

There have been several of them here (some DQ7 by enterolab, and one that was half gene positive by Prometheus or some other lab that tests alpha chains)

Many mainstream labs now test both beta and alpha chains, so you need to get that tested if you want to know.

For explanation of beta and alpha chains, se the HLA DQ page at en.wikipedia.org because the chart there is good.

[danaf617]

The 0301 means DQ7, and many DQ7 have the 05* alpha chain, menaing they have half a DQ2.

There have been several of them here (some DQ7 by enterolab, and one that was half gene positive by Prometheus or some other lab that tests alpha chains)

Many mainstream labs now test both beta and alpha chains, so you need to get that tested if you want to know.

For explanation of beta and alpha chains, se the HLA DQ page at en.wikipedia.org because the chart there is good.

Thanks Nora! The gene stuff is really confusing. So, I've been hearing people say they're DQ2 or DQ8 (those are the main ones, right?) or double DQ5 or whatever.

So what am I? I am just DQ7?

[Skylark]

You are DQ7 and DQ6. The bit that says "Subtype 7,6" on the Enterolab report is where you read it. Don't get too hung up on the genetics. HLA-DQ genetics only give you an idea of relative risk. You have a relatively low risk for celiac, but there are plenty of folks around this board who have gluten intolerance with all different genotypes.

[jerseyangel]

Ladies, if the subtype is 2,5-- of what, if any, significance is the 5 ?

I just find this interesting--already have a diagnosis

[Jestgar]

Try this Open Original Shared Link

They also may be named by antigen instead of gene

Open Original Shared Link

[Skylark]

Ladies, if the subtype is 2,5-- of what, if any, significance is the 5 ?

I just find this interesting--already have a diagnosis

You are DQ2 and DQ5. As far as I know DQ5 isn't associated with any diseases.

Enterolab explains what they mean by "subtype" on this page.

Open Original Shared Link

[jerseyangel]

Thanks!

[nora-n]

Subtype 2,5 can also mean DQ2 with beta 0201 and alpha 0501 (check the charts) as opposed to 2,2 who are 0202 in beta and 0201 in the alpha chain. 2,3 have 0302 in the alpha chain.

Lately they have written the DQ types like that, but Enterolab has not caught up yet as far as I know.

0301 often have 05* alpha and that means it is half a DQ7,5 and is a celiac gene, but there is a much smaller risk than with the main celiac gene HLA DQ2,5.

Several DQ7 have posted here with typical celiac symptoms.

We guess they have the 05* alpha chain. (not all DQ7 have the 05* in alpha)

Enterolab may report the DQ genes differently.

[jerseyangel]

Subtype 2,5 can also mean DQ2 with beta 0201 and alpha 0501 (check the charts) as opposed to 2,2 who are 0202 in beta and 0201 in the alpha chain. 2,3 have 0302 in the alpha chain.

Lately they have written the DQ types like that, but Enterolab has not caught up yet as far as I know.

0301 often have 05* alpha and that means it is half a DQ7,5 and is a celiac gene, but there is a much smaller risk than with the main celiac gene HLA DQ2,5.

Several DQ7 have posted here with typical celiac symptoms.

We guess they have the 05* alpha chain. (not all DQ7 have the 05* in alpha)

Enterolab may report the DQ genes differently.

Thank you Nora--so if I read the chart right the 2 of them form dq2.5 which is linked with a greater frequency of autoimmune disorders including Celiac. Is that right?

[Skylark]

Thank you Nora--so if I read the chart right the 2 of them form dq2.5 which is linked with a greater frequency of autoimmune disorders including Celiac. Is that right?

Enterolab has screwy reporting. They only test beta and they report the really old DQ1-DQ3 HLA serotypes. Then the "subtype" is the modern DQ2, DQ4 - DQ9 typing. It's explained on the FAQ page I linked. It's almost easier to look up the alleles on a better chart. I like Open Original Shared Link

Enterolab dies NOT test alpha chains. Someone who is DQ2 and DQ7 beta by Enterolab testing (alleles 0301, 0202) has a reasonable chance of being DQ2.5 trans but you can't know for sure.

[nora-n]

Yes exactly, it is really confusing that enterolab reports the results in the old format, especially since a new format has been used for a while.

Yes, DQ2,2 which lacks the 05* alpha chain, and is only connected to celiac in a lesser degree, together with DQ7,5, actually forms DQ2,5 by trans.

But we have noticed that some DQ2,2 only , without the DQ7, have celiac symptoms and post here, and the same with DQ7 but they may have the known celaic prone 05* alpha chain.

The 0505 alpha chain alone is half a DQ2 and gives a risk for celiac alone. They even say this alpha chain, 05*, is more strongly associated with celiac than the beta chain part (=0201)

Enterolab says they only test the beta chain to keep costs down.

Currently the American Red Cross does the testing for them, I believe.

I ahve seen reports by labcorp and other labs here where they report both the beta and alpha chains (all jumbled so that can be confusing too, they do not list them together but beta chains in random order and then alpha chains. And, usually they report beta chains then alpha.)

[hoot]

Try the diet for a month or two, it'll probably tell you more than most tests. But if you need it on paper, then obviously get all the tests done.

[danaf617]

Well, in case any one is interested, I had my GI follow-up the other day. I brought the Enterolab results in. He said, "Well, I can't use this to diagnose you but I think that it would be a good idea to do the biopsy." He stated that he does have patients who are blood & biopsy negative but have symptoms disappear on the gluten-free diet and he supports that. He also said he has patients that are blood negative but biopsy positive. He called it sero-negative or serum-negative celiac. (I can't remember which.)

I only started eating gluten free 2 days before and I told him that seeing the positive on the Enterolab for gluten antibodies was enough for me to commit to a strict trial of the gluten-free diet. He asked if I would put it off until after he could do a biopsy and said, "I think it would be irresponsible for me as your doctor to say 'go ahead, cut out gluten' without doing the biopsy first. After the test, you can go gluten-free right away if you'd like."

Oh and he said he typically biopsies six different places. Does that sound sufficient?

So, I'm eating my normal gluten-filled diet until my endoscopy. No matter that results of that, I am going gluten-free on test day to see how I feel.

I'm happy with the appointment and that my doctor is taking my concern seriously even though my blood test was negative.

[Skylark]

That's great! I hope you get things sorted out.

[Marz]

Wow, nice doctor! Very rare to get someone so understanding. Good luck with the rest of the testing.