Testing After Being Gluten Free

[psawyer]

A diagnosis is the result of test results in most cases. Arguing that they are different is semantics.

This whole topic has turned into a heated discussion which long ago ceased presenting new ideas, and is just repeating the same ones over and over. It is time for everyone to move on.

[Jestgar]

But Tom, the study said & I pointed that out but you either missed it or chose to ignore it where it says those serological tests DID NOT REACH STATISTICAL SIGNIFICANCE. That's a pretty strong statement. AND it further said that they observed the TIMING OF INTESTINAL CHANGES DID NOT SIGNIFICANTLY CORRELATE WITH THOSE OF SEROLOGY, SYMPTOMS, OR LAMA.

What do you not understand about that? Or do you refuse to? The serology was NEGATIVE Tom. The serology changed but NOT enough. This is the entire point in this thread.

And I'm sorry if that sounds rude but look what I'm being accused of here. I'm being accused of trying to use completely irrelevant data to prove a point & I AM insulted!

You and Tom are citing reports of the same study. May I suggest you simply read the original paper? Actually the tests DID reach significance for DGP:

This line may have been misleading to the second source of the review:

There was no significant correlation between IgA anti-tTG or IgA/IgG anti-DGP titre and Vh:celiac disease or IEL count at any study visit.

But it's stated under this section compare blood to intestinal damage:

Correlation of non-invasive measures with intestinal histology

We sought to investigate which study end points correlated with the degree of intestinal damage and with change in histology from baseline. Low IEL count at baseline was correlated with greater absolute and per cent change in IEL count from baseline to day 14 (p=0.005 and p=0.003, respectively) but was not correlated with absolute or per cent change in Vh:celiac disease (p=0.711 and p=0.486, respectively). Vh:celiac disease at baseline was not correlated with either absolute or per cent change in Vh:celiac disease (p=0.297 and p=0.068, respectively) or with absolute or per cent change in IEL count from baseline (p=0.103 and p=0.319, respectively). IEL count at baseline was correlated with Vh:celiac disease at baseline (p=0.020) and day 14 (p=0.030) of gluten challenge; however, day 14 IEL count was not correlated with day 14 Vh:celiac disease (p=0.111). Baseline to day 14 change in Vh:celiac disease was not correlated with change in IEL count expressed either as an absolute difference (p=0.345) or as per cent change from baseline (p=0.554).

Change from baseline in IgA anti-tTG was highly correlated with change from baseline in IgA/IgG anti-DGP at both day 14 (p<0.001) and day 28 (p=0.005). There was no significant correlation between IgA anti-tTG or IgA/IgG anti-DGP titre and Vh:celiac disease or IEL count at any study visit. Similarly, there was no significant correlation between absolute change or per cent change from baseline in IgA anti-tTG or IgA/IgG anti-DGP titres and Vh:celiac disease or IEL count at day 14 or in change in Vh:celiac disease or IEL count from baseline.

And this is what the authors recommend:

Based on the data presented, we propose several modifications to the current approach to performing a gluten challenge in clinical practice. Using evidence from this study we propose that a standard gluten challenge be conducted as follows: (1) perform baseline serology testing (IgA anti-tTG and/or IgA/IgG anti-DGP); if results are greater than twice the upper limit of normal for the specific assay in use, proceed directly to duodenal biopsy. Baseline duodenal biopsy in the setting of normal serological testing should be considered in patients known to be positive for HLA DQ2 or DQ8, and in whom gluten challenge is likely to be poorly tolerated necessitating possible abbreviation of challenge; (2) if serology is normal, test for HLA DQ2 or HLA DQ8 and if present, proceed with an initial 2-week gluten challenge at a gluten dose of 3 g per day (equivalent to ∼1