Positive Biopsy, Negative Bloodwork?

[color-me-confused]

Howdy everyone. I am quite confused - I received the results of bloodwork in the mail today. The "transglutaminase IGA ABS" (7), IgG (1130), IgA(233), and IgM(105) tests were all normal. The bloodwork was ordered in the wake of a positive biopsy result for celiac. The endoscopy was due to acid reflux symptoms, so this whole affair was quite surprising. I hope to talk to the GI doc early next week. After 3 days gluten-free I my appetite is suddenly back to normal and the reflux has nearly vanished. Also I was definitely not gluten-free before the blood work. I had it done immediately after the meeting w/ the GI doc.

So what's the deal: positive biopsy means positive for celiac, no matter the blood test results?

[sa1937]

Right, the positive biopsy would trump the negative blood tests.

[MsCurious]

Howdy everyone. I am quite confused - I received the results of bloodwork in the mail today. The "transglutaminase IGA ABS" (7), IgG (1130), IgA(233), and IgM(105) tests were all normal. The bloodwork was ordered in the wake of a positive biopsy result for celiac. The endoscopy was due to acid reflux symptoms, so this whole affair was quite surprising. I hope to talk to the GI doc early next week. After 3 days gluten-free I my appetite is suddenly back to normal and the reflux has nearly vanished. Also I was definitely not gluten-free before the blood work. I had it done immediately after the meeting w/ the GI doc.

So what's the deal: positive biopsy means positive for celiac, no matter the blood test results?

There are a few other things that "mimic" villous atrophy in the small intestines, and it could take an expert lab tech to tell the difference, but having said that... if you do have symptoms of Celiac, that could very well be what it is, without positive serology.

Hopefully, you have a good doctor, and good lab that can make the distinction for you. I know there is a condition that looks similar to villous atrophy that can be treated with a drug that resolves the issue. I do have a video source for physicians that you could look at if you like. It could always be sent to your doctor for review.

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[MsCurious]

Bleh... hiccup! Please removed if/when you see this, kind moderator. Sorry!

[ravenwoodglass]

" After 3 days gluten-free I my appetite is suddenly back to normal and the reflux has nearly vanished."

You had a positive biopsy and just a short time into the diet you are already seeing positive results. False negatives on biopsy and blood tests are not uncommon and it appears that your blood test may have been a false negative. Trust your bodies response to being gluten free and the biopsy and stick to the diet and continue to heal.

If you do continue to have issues then of course other conditions may need to be ruled out but it appears you have the answer as to why your biopsy was positive.

[color-me-confused]

Thank you for the responses everyone. I will wait very impatiently to speak w/ my GI doc on Monday. It's a good place, and they have the data from a gastroscopy 5 years ago. like I stated I was blindsided by the diagnosis, in the next conversation I'll have a ton of questions to ask.

[color-me-confused]

I found this interesting article on this very site:

https://www.celiac.com/articles/817/1/False-Negative-Serological-Results-Increase-with-Less-Severe-Villous-Atrophy/Page1.html

Out of those studied, 71% had total villous atrophy, and 29% had partial villous atrophy. Serological results indicated that only 77% of those with total and 33% of those with partial villous atrophy actually tested positive for celiac disease, and it did not matter whether the patients presented with classical or silent symptoms. All patients who were positive for anti-tissue transglutaminase had total villous atrophy. The researchers conclude:

seronegative celiac disease occurs. Endomysial antibody positivity correlates with more severe villous atrophy and not mode of presentation of celiac disease. Serologic tests, in clinical practice, lack the sensitivity reported in the literature.

interesting. I hate waiting for medical news.

[MsCurious]

I hate waiting for medical news.

ME TOOOOO! My testing starting end of January and won't be over until mid April... at least IF its celiac disease or NCGS. Keep us posted on your progress! Good progess reports always give me hope.

[color-me-confused]

I've finally heard back from the doc...it looks like between the degree of inflammation found, the negative bloodwork, and the improved wellbeing after a week off of gluten that the proper diagnosis is gluten sensitivity but not celiac. I have a face-to-face in a couple of weeks during which I'll ask a raft of questions and I will stick to the gluten free diet since I do feel better on it. Especially now that the headaches are fading away.

[ravenwoodglass]

I've finally heard back from the doc...it looks like between the degree of inflammation found, the negative bloodwork, and the improved wellbeing after a week off of gluten that the proper diagnosis is gluten sensitivity but not celiac. I have a face-to-face in a couple of weeks during which I'll ask a raft of questions and I will stick to the gluten free diet since I do feel better on it. Especially now that the headaches are fading away.

Glad your sticking with the diet and it is helping. He also didn't order a full celiac panel so you might have been positive on the tests he didn't order although I certainly would not advise you to go back on gluten for a couple of months to get them done.