Lab Results Are So Confusing!

[21daisygurl]

I am SO glad I found this forum!

I have had gastro issues my whole life and despite mentioning it to my doc, noone did any further testing. I have long suspected I am gluten sensitive since I react to gluten products. However, my family doc suggested I see a naturopath to do an elimination diet to see if it really is gluten or something else I am sensitive to. Just for kicks, she threw in some blood work and we were both surprised it came back abnormal.

Here are just the celiac ones I had done (I know there are other tests but these are the ones I had run):

IgA: 1.90 (range 0.69-3.82)

Gliadin IgA: 3.5 (range <11.99)

Gliadin IgG: 23.2 (HIGH) (range <11.99)

Transglutaminase IgA: 2.3 (range <9.99)

In addition my Iron and hemoglobin were low, and my ESR was double the max normal range. Suggesting there is inflammation and probably a bleed.

I know from my research that the Transglutaminase is more specific for celiac, but if my Gliadin is positive, wouldn't that mean I react to gluten? So what is the point of doing a biopsy if I know I react to gluten? And only one of the gliadin immunoglobulins was positive - why not both?

Is the biopsy worth having done? I am waiting to hear from a gastroenterologist but all this is so confusing - I could use some help!

I can't make any diet changes till the biopsy is done - but I don't want my gut to get more damaged than it clearly already is (judging by the inflammation and bleeding).

Thoughts?

[alicewa]

It's a question we all ask ourselves. I had the whole lot done except for the gene test. I was positive for tTG as well as IgG Gliadin and had a positive endoscopy.

Your case doesn't sound as serious as mine. You may have a normal biopsy as a matter of fact due to tTG being normal.

[ravenwoodglass]

You can have all those tests come back negative and still be very, very ill from celiac. You can also have a false negative on the biopsies. No matter what the results of the biopsy you need to go gluten free when that test is done. Whether you want to have the biopsy done is up to you. Your doctor may give you an official diagnosis with positive blood work and remission of symptoms on the diet. If an official diagnosis is of value to you and you are reluctant to have the endo you could talk to your doctor about diagnosing that way.

Do stay on gluten until all the celiac related tests you choose to do are done and then get on the diet.

[Skylark]

Hard to know what that panel means, other than your immune system recognizes gluten. You'd have to get a biopsy to discover whether it's celiac or intolerance becasue anti-gliadin IgG can go either way. To my way of thinking, with weird labs it's definitely worth getting the biopsy done.

[alicewa]

Here's are two videos by Rodney Ford. It's definitely worth the 10 minutes in total or so to watch them because he talks about a girl who is in a similar situation to yours. The second one talks about various gluten tests and how they work.

Hard to know what that panel means, other than your immune system recognizes gluten. You'd have to get a biopsy to discover whether it's celiac or intolerance becasue anti-gliadin IgG can go either way. To my way of thinking, with weird labs it's definitely worth getting the biopsy done.

Are false negatives worse with labs than the biopsy?

I'd say if the original poster has been eating gluten all along, she might as well have the biopsy if she can.

[nora-n]

I woud suggest getting the new deaminated gliadin tests done, both the IgA and IgG versions, since we have had several people here with symptoms and negative ttg, but positive DGP.

That one is very specific for celiac and can pick up patchy celiac.

The ttg test is very bad at picking up patchy celiac.

Patchy celiac is the most common for of celiac nowadays.

[peeptoad]

Hard to know what that panel means, other than your immune system recognizes gluten. You'd have to get a biopsy to discover whether it's celiac or intolerance becasue anti-gliadin IgG can go either way. To my way of thinking, with weird labs it's definitely worth getting the biopsy done.

Re: the bolded type. This is what confuses me about the lab tests... if a person's body recognizes gluten (or anything else for that matter) as something it needs to produce antibodies against, doesn't that automatically make that substance (gluten, or whatever) a problem for that person regardless of how much antibody production occurs?

[ravenwoodglass]

Re: the bolded type. This is what confuses me about the lab tests... if a person's body recognizes gluten (or anything else for that matter) as something it needs to produce antibodies against, doesn't that automatically make that substance (gluten, or whatever) a problem for that person regardless of how much antibody production occurs?

I think so. Antibody production can also build up so a low positive on a celiac test could go into a strong postive down the line. IMHO even if the antibodies are at low levels it is wise to drop what is causing the antibodies rather than continueing to injest until your antibodies reach high levels.

[21daisygurl]

Re: the bolded type. This is what confuses me about the lab tests... if a person's body recognizes gluten (or anything else for that matter) as something it needs to produce antibodies against, doesn't that automatically make that substance (gluten, or whatever) a problem for that person regardless of how much antibody production occurs?

AH this is what I was getting at in my OP. Since my body clearly produces antibodies against gluten, whether or not I am celiac shouldn't matter, so much as the fact that my gut is leaky to gluten, correct?

I am going to go watch those video's posted - I appreciate the opinions. I hope I get in to see the specialist soon!

[peeptoad]

I think so. Antibody production can also build up so a low positive on a celiac test could go into a strong postive down the line. IMHO even if the antibodies are at low levels it is wise to drop what is causing the antibodies rather than continueing to injest until your antibodies reach high levels.

Now, that makes sense...

[Skylark]

Re: the bolded type. This is what confuses me about the lab tests... if a person's body recognizes gluten (or anything else for that matter) as something it needs to produce antibodies against, doesn't that automatically make that substance (gluten, or whatever) a problem for that person regardless of how much antibody production occurs?

The usual antibody in the intestines is IgA since you have normal IgA. IgG is an antibody more associated with allergy, if anything. People can have IgG antibodies to foods and nothing happens at all when they eat them because the food doesn't get to the bloodstream to react with the IgG. Other people are quite sensitive to their IgG foods.

You need the biopsy to know whether you're celiac and the IgA just doesn't happen to be making it into the bloodstream, or whether you're gluten intolerant and not having autoimmune problems. (A nicer situation because there isn't the cancer risk.)

[mash]

My understanding is that IgG is actually a kind of "transient" intolerance as opposed to a lifelong one. Read this document: Open Original Shared Link).pdf where they explain that once your IgG test comes back positive, they will take you off a specific foodstuff for a while and then make a decision on whether or not to reintroduce it.

With Celiac Disease (lifelong intolerance), they are only really looking at IgG if you are IgA deficient.

So yes, you probably need to cut out the gluten, but it might not be for the rest of your life, you might be able to reintroduce it and then test again?

[Skylark]

Mash, SOME celiacs do show IgG in blood, but there is also IgA in the mucosa and damage. The only way to know is the biopsy. Agreed that IgG is more often associated with intolerance, and that some IgG intolerance can be transient.

[21daisygurl]

My understanding is that IgG is actually a kind of "transient" intolerance as opposed to a lifelong one. Read this document: Open Original Shared Link).pdf where they explain that once your IgG test comes back positive, they will take you off a specific foodstuff for a while and then make a decision on whether or not to reintroduce it.

With Celiac Disease (lifelong intolerance), they are only really looking at IgG if you are IgA deficient.

So yes, you probably need to cut out the gluten, but it might not be for the rest of your life, you might be able to reintroduce it and then test again?

Thank you for that document! That sounds exactly right - I did have an inflammatory response based on the bloodwork so this delayed food allergies and chronic complaints sounds like me for sure.

Still haven't heard from the gastroenterologist but I am really enjoying reading all of your different thoughts on this. I really appreciate the constant insight. I am learning so much from you guys.