Wamedh Taj-Aldeen

Thanks for your response and thoughts. Total IgA is normal. HLA DQ2/DQ8 came as heterozygous and the interpretation of the lab that the risk of coeliac disease is mild to moderate. Thyroid function test is normal. I agree that the best way is to repeat tTG antibodies in 6 months time as the result was not massively high.  

I recently reviewed a patient with a positive tissue transglutaminase (tTG) antibody but negative endomysial antibodies (EMA). The patient is asymptomatic, and duodenal biopsies—taken while on a normal gluten-containing diet—were reported as normal.

Given the discordant serology and absence of histological changes, I understand that the probability of coeliac disease is low. However, I would appreciate your guidance on the following:

Is routine follow-up required in such a case?

What is the risk of progression to overt coeliac disease in the future?

Would HLA DQ2/DQ8 typing be useful here to help guide long-term management or exclude the diagnosis confidently?

I would be grateful for your thoughts.