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Celiac Testing. Ttg Tests Not The Most Accurate To Detect Early Stage celiac disease


answerseeker

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answerseeker Enthusiast

Here's an interesting article. Only 64% accuracy with the ttg test in early stage celiac. Kaiser doesn't do the whole panel. It's so important to get the celiac panel because you can see in this article the accuracy goes up pretty significantly with the ema tests. This refers to early stage celiac with little or no villi damage (marsh I)

www.ncbi.nlm.nih.gov/m/pubmed/21063208/

My insurance changes in Jan, no more Kaiser. I'm getting my children retested with the whole celiac panel


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nvsmom Community Regular

Interesting. The EMA IgA's ability to detect early celiac disease surprised me. It usually doesn't show up until there is already damage (from tTG IgA) and then it tries to wipe out the top damage layer of the villi... like a second wave of attack.  At least that how I understood it. :ph34r:

answerseeker Enthusiast

I think they are always learning new things about this disease! I don't think there is enough research yet in early stage celiac. But it does seem to me that the ttg has a high false negative. My kids tested almost the same exact numbers on the ttg as I did and as each other did which is odd to me. My ttg was false negative. I thought it was due to prednisone but this makes me wonder. Regardless, they are getting a whole celiac panel done the minute our insurance changes!

NoGlutenCooties Contributor

I can't put my finger on where I read this but I remember seeing that a negative bloodtest is only about 70% accurate.  However, a positive bloodtest is about 97% accurate.  Also, it is important to get the actual numbers from the doctor (which it sounds like you did) rather than just the "positive" or "negative".  There are discrepancies in what different labs and different doctors consider "positive".  For example, my doctor doesn't consider it to be a positive result unless the number is over 11.  But most nutritionalists will tell you that anything over 3 is positive - just not "positive enough" for the insurance companies to want to pay for the endoscopy.  In this case you'd have to get tested annually and see if the number goes up.

nvsmom Community Regular

The numbers that I usually quote are from the Open Original Shared Link On page 12 it shows that the tTG IgA's sensitivity (how many cases of celiac disease out of 100 it would catch) is 75-95% - meaning it misses 5-25% of celiac disease with false negatives- and the specificity (how many cases of 100 positives are actually celiac disease) is 91-99% - meaning 1-9% of all positive tests are false positives for celiac disease and probably attributed to something else like crohn's, colitis, diabetes, thyroiditis, liver disease, or some other infection.

 

False negatives are definitely more common than false positives.

 

I'm glad you have a doctor who will interpret the grey areas, NoGlutenCooties. Most doctors won't, there is just positive or negative nevermind that the numbers seperating them may be next to nothing.

NoGlutenCooties Contributor

I'm glad you have a doctor who will interpret the grey areas, NoGlutenCooties. Most doctors won't, there is just positive or negative nevermind that the numbers seperating them may be next to nothing.

 

I actually insist on getting the specific numbers from the doctor, to include a copy of the test results, and do my own independent research.  I don't trust doctors to explain - or even to really know - what the grey areas mean.

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    • Scott Adams
      The first set of results show two positive results for celiac disease, so at the very least it looks like you could have it, or at the least NCGS.   Approximately 10x more people have non-celiac gluten sensitivity than have celiac disease, but there isn’t yet a test for NCGS. If your symptoms go away on a gluten-free diet it would likely signal NCGS.      
    • Scott Adams
      Elevated tissue transglutaminase IgA (tTG-IgA) levels are highly specific for celiac disease, and they are a key biomarker used in its diagnosis. However, there are some rare instances where elevated tTG-IgA levels have been reported in conditions other than celiac disease. While these cases are not common, they have been documented in the literature. Below are some examples and references to studies or reviews that discuss these scenarios:  1. Non-Celiac Gluten Sensitivity (NCGS)    - NCGS typically does not cause elevated tTG-IgA levels, as it is not an autoimmune condition. However, some individuals with NCGS may have mild elevations in tTG-IgA due to intestinal inflammation or other factors, though this is not well-documented in large studies.    - Reference: Catassi, C., et al. (2013). *Non-Celiac Gluten Sensitivity: The New Frontier of Gluten-Related Disorders*. Nutrients, 5(10), 3839–3853. [DOI:10.3390/nu5103839](https://doi.org/10.3390/nu5103839)  2. Autoimmune Diseases    - Elevated tTG-IgA levels have been reported in other autoimmune conditions, such as type 1 diabetes, autoimmune hepatitis, and systemic lupus erythematosus (SLE). This is thought to be due to cross-reactivity or polyautoimmunity.    - Reference: Sblattero, D., et al. (2000). *The Role of Anti-Tissue Transglutaminase in the Diagnosis and Management of Celiac Disease*. Autoimmunity Reviews, 1(3), 129–135. [DOI:10.1016/S1568-9972(01)00022-3](https://doi.org/10.1016/S1568-9972(01)00022-3)  3. Chronic Liver Disease    - Conditions like chronic hepatitis or cirrhosis can sometimes lead to elevated tTG-IgA levels, possibly due to increased intestinal permeability or immune dysregulation.    - Reference: Vecchi, M., et al. (2003). *High Prevalence of Celiac Disease in Patients with Chronic Liver Disease: A Role for Gluten-Free Diet?* Gastroenterology, 125(5), 1522–1523. [DOI:10.1016/j.gastro.2003.08.031](https://doi.org/10.1016/j.gastro.2003.08.031)  4. Inflammatory Bowel Disease (IBD)    - Some patients with Crohn’s disease or ulcerative colitis may have elevated tTG-IgA levels due to intestinal inflammation and damage, though this is not common.    - Reference: Walker-Smith, J. A., et al. (1990). *Celiac Disease and Inflammatory Bowel Disease*. Journal of Pediatric Gastroenterology and Nutrition, 10(3), 389–391. [DOI:10.1097/00005176-199004000-00020](https://doi.org/10.1097/00005176-199004000-00020)  5. Infections and Parasites    - While infections (e.g., giardiasis) are more commonly associated with false-positive tTG-IgA results, chronic infections or parasitic infestations can sometimes lead to elevated levels due to mucosal damage.    - Reference: Rostami, K., et al. (1999). *The Role of Infections in Celiac Disease*. European Journal of Gastroenterology & Hepatology, 11(11), 1255–1258. [DOI:10.1097/00042737-199911000-00010](https://doi.org/10.1097/00042737-199911000-00010)  6. Cardiac Conditions    - Rarely, heart failure or severe cardiovascular disease has been associated with elevated tTG-IgA levels, possibly due to gut ischemia and increased intestinal permeability.    - Reference: Ludvigsson, J. F., et al. (2007). *Celiac Disease and Risk of Cardiovascular Disease: A Population-Based Cohort Study*. American Heart Journal, 153(6), 972–976. [DOI:10.1016/j.ahj.2007.03.019](https://doi.org/10.1016/j.ahj.2007.03.019)  Key Points: - Elevated tTG-IgA levels are highly specific for celiac disease, and in most cases, a positive result strongly suggests celiac disease. - Other conditions causing elevated tTG-IgA are rare and often accompanied by additional clinical findings. - If celiac disease is suspected, further testing (e.g., endoscopy with biopsy) is typically required for confirmation. If you’re looking for more specific studies, I recommend searching PubMed or other medical databases using terms like "elevated tTG-IgA non-celiac" or "tTG-IgA in non-celiac conditions." Let me know if you’d like help with that!
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    • trents
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    • Jack Common
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