Test Help.

[VOZDUK]

Hello,

About a year and a bit ago I started getting stomach symptoms(gas, pain, diarrhea, constipation and etc) and it took me about 8 months to do something about it and I got a blood test done(ceoliac scan) and these were the results of the test.

Coeliac Disease Serology (SERUM)

Gliadin IgA (EIA) 6 units - Normal (< 20)

Transglutaminase IgA Ab (EIA) 72 units - Normal (< 20)

Total IgA 2.05 g/L (0.85-3.70)

Following these results I booked for a biopsy but as the appointment was two weeks after booking I jumped straight into a gluten free diet as I found the urge of getting rid of what I had to hard to resist but ended up eating a bit of gluten a day prior to the test. The biopsy came up wit the following.

Microscopy

1. Sections show mild inflammation to this gastric antral mucosa with some slight congestion to the lamina propria. The glandular epithelium is well differentiated and there is no evidence of intestinal metaplasia in the sections examined. The stain for Helicobacter-like organisms is negative.

2. Sections show well defined villi to this small bowel mucosa with a normal crypt/villus ratio present and a minor degree of congestion in the lamina propria. There is no inflammation, ulceration or atypia and Giardia lamblia were not identified.

Jump forward 6 months and I tried my hardest to follow a gluten free diet and am still suffering from the same symptoms. Just recently I had another blood test (Ceoliac scan) which showed the following.

Coeliac Disease Serology (SERUM)

Gliadin IgA (EIA) 8 units - Normal (< 20)

Transglutaminase IgA Ab (EIA) 93 units - Normal (< 20)

Total IgA 2.22 g/L (0.85-3.70)

Looking at the test the Transglutaminase IgA has gotten worse by 21 units which shocked me. What does this mean? Can anyone help me out?

[ravenwoodglass]

It likely means you are still getting gluten somewhere, IMHO. What is your typical diet like? Are you going with mostly whole unprocessed foods and avoiding restaurants? Is your home gluten free and if it isn't have you got your own new dedicated toaster, condiments, butter, pnut butters and jelly etc? I take it by your spelling you are in Europe, are you eating products with Codex Wheat starch? Although thought to be gluten free many of us do not tolerate them. Do you work around wheat flour or in the home remodeling profession? Airborne wheat can be an issue as can stuff like drywall compound, wall paper paste etc.

[Skylark]

With negative anti-gliadin IgA, negative biopsy, and lack of response to the diet you might not be celiac. Your doctor should have tested you for anti-endomysial antibodies or anti-deamidated gliadin peptide when your biopsy came back normal.

Have you been checked for Crohn's disease, ulcerative colitis, or chronic liver disease? Anti-TTG can be elevated in these conditions and anti-gliadin IgA is not. There are also not anti-endomysial antibodies. Sadly at this point you've been gluten-free long enough that the anti-EMA may not be accurate.

Raven also makes a good point that the gluten-free diet has to be very strict, but it seems to me that you would be feeling somewhat better even if you haven't done it perfectly.

[ravenwoodglass]

In addition to the conditions Skylark mentioned TTG can also be falsely positive in some other instances so make sure those have been ruled out also. From what I understand the new anti-deamidated gliadin peptide is the best test so far.

Open Original Shared Link

Tissue transglutaminase antibodies or TTG

Since tTG had been first described as the autoantigen of celiac disease in 1997, it has been utilized to develop innovative diagnostic tools. The tTG IgA ELISA test is highly sensitive and specific. The tTG assay correlates well with EMA-IgA and biopsy. However, it represents an improvement over the antiendomysial antibody assay because it inexpensive, rapid, is not a subjective test, and can be performed on a single drop of blood using a dot-blot technique. One negative aspect of the TTG antibody is that it can be falsely positive in a patient who has another autoimmune condition. TTG false positivity has been described in patients with both type I diabetes and autoimmune hepatitis. Theoretically, it can also be falsely positive in other autoimmune disease

[Skylark]

That's a good link, Raven! I believe TTG also shows up in rheumatoid arthritis, but that gives joint pain rather than GI symptoms.

[ravenwoodglass]

That's a good link, Raven! I believe TTG also shows up in rheumatoid arthritis, but that gives joint pain rather than GI symptoms.

What I find interesting is that my gene is considered an RA associated gene in the US but is considered a celiac related gene in other countries. If I had been gene tested before being diagnosed celiac I would have been labeled with RA since I had a lot of joint impact and other RA features. Since many RA patients also have 'IBS' they would have stopped looking there.

It really makes me wonder how many RA patients may actually be celiac along with many others that have other associated autoimmune disorders. In other words are those really false positives with the TTG or is it that perhaps the IGA tests are false negatives. With the high rate of undiagnosed celiacs here how many would benefit from the diet even with a negative test but are told it couldn't be the root of their issues.