Help Interpreting Test Results

[Chuck1004]

I can't thank everyone enough to for the feedback they provided over the past few days. It's really help me come to grips with my new diagnosis.

Speaking of, I received the results in the mail. Can I get some feedback again on specifically what it means? I asked the Doctor yesterday if there was a Marsh level for me and she indicated they didn't specifically test for that. Here's what I did receive.

Final Pathologic Diagnosis:

A. Duodenum Biopsy - Duodenal mucosa with increased intraepithelial lymphocytes and normal villous architecture; (see note)

Note: A CD3 immunostain demonstrates increased intraepithelial lymphocytes throughout most of the architecturally preserve villi. Although non-specific, in conjunction with the known positive serum IgA TTG, the findings support a diagnosis of celiac disease.

Gross Description - Received in formalin, is .4 x .3 x.1 cm aggregate of tissue fragments. Entirely in A1.

Prior to receiving the results my fear was the IgA TTG was going to point me elsewhere. Is this more conclusive than it sounds?

[GottaSki]

"CD3 immunostain demonstrates increased intraepithelial lymphocytes throughout most of the architecturally preserve villi"

Increased lymphocytes is certainly part of Celiac Disease...that your villi seem to have little damage is great news.

I don't recall what your tTG IgA result was...there are often false negatives, but positive is positive for Celiac Disease -- a positive antibody test together with increased intraepithelial lymphocytes is certainly enough for a diagnosis.

Sounds like you are fortunate to have the gotten the diagnosis before more serious damage was done to your intestinal walls.

Welcome and Good Luck to you!

[Chuck1004]

Thanks Lisa!

My TTG IGA was 45.62, with the normal range being 0-15. My antigliadin antibodies were both normal. When that was the only result I had back, I had read online that, "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."

As I'm asymptomatic and had mildly elevated LFT/fatty liver, I was afraid it would be one of the other issues mentioned above. I guess my issue when I posted today was do I have two inconclusive results that together may mean celiac's disease or two inconclusive results that together almost certainly mean celiac disease.

Put another way, intraepithelial lymphocytes couldn't mean anything else, right?

And thank you very much!!!

[Chuck1004]

And followup stupid question of the day, but do the symptoms generally follow villi damage? I wondered if the normal villi was why I might be asymptomatic.

[Skylark]

You have a Marsh 1 biopsy. The intraepithelial lymphocytes are CD3+ natural killer cells that have infiltrated your intestinal epithelium from your lymph nodes. This is the first stage of celiac disease. They are being directed to kill your villi by the anti-TTG antibodies. There isn't much chance anything else is going on. Celiac can elevate liver enzymes.

It's possible that you are less symptomatic because of the lower level of damage. Do remember that a biopsy only looks at a tiny fraction of your intestine and there could be more damage elsewhere.

[GFinDC]

Hi Chuck,

Here is an article on Nature.com from The American Journal of Gastroenterology that discusses the Marsh score for damage to the villi in celiac disease.

Open Original Shared Link

This article discusses the antibodies and testing:

Interpretation of Celiac Disease Blood Test Results celiac com

[GottaSki]

  On 3/4/2012 at 1:49 AM, Chuck1004 said:

And followup stupid question of the day, but do the symptoms generally follow villi damage? I wondered if the normal villi was why I might be asymptomatic.

That is not a stupid question and even if it were -- this is the place to ask any question with regard to Celiac Disease!

Your theory would be true if comparing just you and I because I had severe symptoms for many years before I was finally diagnosed - my original endo revealed severe villi atrophy and all my biopsies were very high on the Marsh Scale.

[Chuck1004]

Thank you everybody for the information. That was exactly what I was looking for!

I'm about to go and restock the shelves with gluten free products so I'm not walking around the house drooling. Plenty of gluten free wraps and buns so I can at least look at the local burger joint without tearing up.