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Celiac, Anorexia, Or Both?


MomOfTwins98

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MomOfTwins98 Newbie

I'm new to this forum. My 13-year old daughter was just recently diagnosed with celiac disease. Her blood test was showing the following results:

Celiac Disease Panel

Endomysial Antibody IgA --- Positive ----- Abnormal

t-Transglutaminase (tTG) IgA --- 20 ---------- High

Then, she had the Small Intensine Biopsy done. The Pathology Report has the following note: "The findings are mild, focal and non-specific. Possible etiologies include celiac disease as well as other immune-mediated processes, infection, peptic injury and medications. However, in the appropriate clinical setting, with appropriate serologic findings, these factors are compatible with celiac disease"

Do the above results indicate celiac beyond any doubt? The words "mild, focal and non-specific" are confusing to me...

My D was diagnosed with Anorexia in the beginning of November. She had a lot of classic signs of anorexia (big weight loss, preoccupation with fat content of food, excessive exercise). Once diagnosed with AN, we started refeeding at home using a Maudsley approach. She started eating normally with no problems at all (same amounts as prior to getting sick). Then, as we started increasing the number of calories, she still wasn't gaining any weight. Last week, she started a day program for eating disorders (lost more weight in the preparation for colonoscopy/endoscopy testing), and it became very clear to me that she doesn't quite belong there - unlike other girls, she doesn't have distorted body image, she is eating quite a lot (but refusing some type of foods), not really depressed. Sometime during the process, the pediatrician ordered the above blood test, and based on abnormal results, we met with a GI doctor who later performed the biopsy. Few days ago we received the results of the biopsy, based on which it was concluded that she does have celiac disease. We started the gluten-free diet 2 days ago. Now, I can't stop wondering whether she has anorexia, and if so, will the gluten free diet be helpful with the weight gain. Anyone encountered similar scenerio?


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Those results would have me convinced it's celiac. There are a few other things that can bring up tTG, but it's not common. EMA is highly specific to celiac disease. If she's going to have the endoscopy as well make sure it happens right away or she stays on gluten until it is done.

People thought my daughter had anorexia, but it turned out she just needed the GAPS diet to get her eating again. She used to be so picky (and hated fat, loved sugar!), but the dietary changes helped her sensory processing issues and made a *huge* difference. Now she loves to eat.

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    • trents
      Welcome to the forum, @Judy M! Yes, he definitely needs to continue eating gluten until the day of the endoscopy. Not sure why the GI doc advised otherwise but it was a bum steer.  Celiac disease has a genetic component but also an "epigenetic" component. Let me explain. There are two main genes that have been identified as providing the "potential" to develop "active" celiac disease. We know them as HLA-DQ 2.5 (aka, HLA-DQ 2) and HLA-DQ8. Without one or both of these genes it is highly unlikely that a person will develop celiac disease at some point in their life. About 40% of the general population carry one or both of these two genes but only about 1% of the population develops active celiac disease. Thus, possessing the genetic potential for celiac disease is far less than deterministic. Most who have the potential never develop the disease. In order for the potential to develop celiac disease to turn into active celiac disease, some triggering stress event or events must "turn on" the latent genes. This triggering stress event can be a viral infection, some other medical event, or even prolonged psychological/emotional trauma. This part of the equation is difficult to quantify but this is the epigenetic dimension of the disease. Epigenetics has to do with the influence that environmental factors and things not coded into the DNA itself have to do in "turning on" susceptible genes. And this is why celiac disease can develop at any stage of life. Celiac disease is an autoimmune condition (not a food allergy) that causes inflammation in the lining of the small bowel. The ingestion of gluten causes the body to attack the cells of this lining which, over time, damages and destroys them, impairing the body's ability to absorb nutrients since this is the part of the intestinal track responsible for nutrient absorption and also causing numerous other food sensitivities such as dairy/lactose intolerance. There is another gluten-related disorder known as NCGS (Non Celiac Gluten Sensitivity or just, "gluten sensitivity") that is not autoimmune in nature and which does not damage the small bowel lining. However, NCGS shares many of the same symptoms with celiac disease such as gas, bloating, and diarrhea. It is also much more common than celiac disease. There is no test for NCGS so, because they share common symptoms, celiac disease must first be ruled out through formal testing for celiac disease. This is where your husband is right now. It should also be said that some experts believe NCGS can transition into celiac disease. I hope this helps.
    • Judy M
      My husband has had lactose intolerance for his entire life (he's 68 yo).  So, he's used to gastro issues. But for the past year he's been experiencing bouts of diarrhea that last for hours.  He finally went to his gastroenterologist ... several blood tests ruled out other maladies, but his celiac results are suspect.  He is scheduled for an endoscopy and colonoscopy in 2 weeks.  He was told to eat "gluten free" until the tests!!!  I, and he know nothing about this "diet" much less how to navigate his in daily life!! The more I read, the more my head is spinning.  So I guess I have 2 questions.  First, I read on this website that prior to testing, eat gluten so as not to compromise the testing!  Is that true? His primary care doctor told him to eat gluten free prior to testing!  I'm so confused.  Second, I read that celiac disease is genetic or caused by other ways such as surgery.  No family history but Gall bladder removal 7 years ago, maybe?  But how in God's name does something like this crop up and now is so awful he can't go a day without worrying.  He still works in Manhattan and considers himself lucky if he gets there without incident!  Advice from those who know would be appreciated!!!!!!!!!!!!
    • Scott Adams
      You've done an excellent job of meticulously tracking the rash's unpredictable behavior, from its symmetrical spread and stubborn scabbing to the potential triggers you've identified, like the asthma medication and dietary changes. It's particularly telling that the rash seems to flare with wheat consumption, even though your initial blood test was negative—as you've noted, being off wheat before a test can sometimes lead to a false negative, and your description of the other symptoms—joint pain, brain fog, stomach issues—is very compelling. The symmetry of the rash is a crucial detail that often points toward an internal cause, such as an autoimmune response or a systemic reaction, rather than just an external irritant like a plant or mites. I hope your doctor tomorrow takes the time to listen carefully to all of this evidence you've gathered and works with you to find some real answers and effective relief. Don't be discouraged if the rash fluctuates; your detailed history is the most valuable tool you have for getting an accurate diagnosis.
    • Scott Adams
      In this case the beer is excellent, but for those who are super sensitive it is likely better to go the full gluten-free beer route. Lakefront Brewery (another sponsor!) has good gluten-free beer made without any gluten ingredients.
    • trents
      Welcome to the forum, @catsrlife! Celiac disease can be diagnosed without committing to a full-blown "gluten challenge" if you get a skin biopsy done during an active outbreak of dermatitis herpetiformis, assuming that is what is causing the rash. There is no other known cause for dermatitis herpetiformis so it is definitive for celiac disease. You would need to find a dermatologist who is familiar with doing the biopsy correctly, however. The samples need to be taken next to the pustules, not on them . . . a mistake many dermatologists make when biopsying for dermatitis herpetiformis. 
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