Am I Celiac?

[jgj6331]

Sorry - I'm a complete newbie..... forgive me in my naviety.I am a 55 year old male and have a past hx of early-onset coronary artery disease(age 40). Due to episodic bouts of malaise and joint stiffness (along with one weakly-positive RA factor that has not been duplicated) I was dx'd as rheumatoid about 10 years ago and treated with plaquenil since that time. In 2009 I underwent a partial colectomy for recurrent bouts of diverticulitis. For many years my blood counts have been slightly low to low normal and attributed to mild anemia of chronic disease......... but over the past couple of years my eosinophil count has gradually climbed from normal to 20% late last year. I have had minor episodic GI complaints most of my life - bouts of sour stomach, pruritis, occasional diarrhea - but nothing severe or persistent enough to warrant evaluation. I've never had evidence of dermatitis herpetiformis . My stools have been "floaters" most of my life - but nothing I'd call steatorrhea. Flatulence has gradually increased with age and stools do seem more "greasy" (harder to clean) over the past few years (pretty picture, huh?). My sense of balance doesn't seem to be as good as it once was - but I figure this may be age-related. Having read a few articles on celiac disease recently, I wondered if that might be a consideration. I had a "celiac panel" - IgG Gliadin peptide Ab was positive at 27.1 (normal < 20).... IgA Gliadin peptide Ab, IgA Endomysial Ab and IgA level were all normal. I consulted with a GI doc last month who wanted to do small bowel biopsy - which I have yet to schedule. Concerned over the high eosinophil count, I tried a gluten-free diet for a month and repeated the blood count......... the eosinophils were normal (6). I re-challenged with gluten for 2 weeks and the count rose to 15. I have re-instated the diet and will recheck the eosinophils in a couple of months. So - do I have enough evidence to be considered celiac or should I investigate further??? Any suggestions / advice would be greatly appreciated.......

[jgj6331]

I appreciate the 4 poll votes.... but the poll was merely an aside.... what I need are suggestions and answers. Anybody???

[MitziG]

Yes you have celiac. The positive test alone is generally enough- false positives are exceedingly rare. The fact that your count dropped when you went gluten-free and rose in response to a very short gluten challenge merely confirms that yes, gluten is a problem for you.

An endoscopy would likely (but not necessarily) confirm this. Biopsies can easily (and often do) miss damaged villi, depending on the extent of the damage and the number of samples taken, combined with the experience of the tech reading them. So...if your only reason for doing an endoscopy is to confirm what is already blatantly obvious- I would not bother.

However, endoscopy can be valuable in asessing the current state of your intestines. Say, a year from now, your gastro-intestinal symptoms are persisting. Then they can go back in and do a comparison and see what is happening. There are rare instances of "refractory celiac" where villi do not heal with a gluten free diet, and additional measures must be taken. But that is rare, as I said.

If you choose to do endoscopy, be sure to continue eating gluten until it is done. Villi heal quickly, and even a short time gluten free can cause damage to disappear, rendering the biopsy negative.

So...the choice to do endoscopy is yours. But be assured, regardless of the results, or what your GI may tell you (most are NOT well versed in Celiac) you definitely DO have celiac and need to be gluten free the rest of your life.

[jgj6331]

MitziG - thanks for the response. I think biopsy would actually add nothing at this juncture - if it's not full-blown celiac - it is at least a sensitivity that is dinking around with my white cells - and that can't be good... The treatment would likely be the same.... That my count dropped tells me I was making decent headway into a gluten-free diet - at least on a biological level.