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Positive gliadin (deamidated) IgG, normal everything else?

phosphene
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phosphene Newbie
phosphene
Posted

I've been searching through this forum and online but haven't gotten a clear answer, so I thought I would post my results specifically. My understanding is that a high gliadin IgG isn't really enough for a diagnosis, but what does it mean? I'm pretty confused. I definitely do have stomach and inflammation issues, but is it celiac or a sensitivity? With my endoscopy and biopsies I haven't gotten these results and my doctor recommended to do another biopsy. But I'd like to know what you guys think and if you've seen this before. Thank you in advance <3

Here are my blood test results:

- tissue transglutaminase Ab, IgG: Normal <1.0

- tissue transglutaminase Ab, IgA Normal <1.0

- gliadin (deamidated) Ab (IgA). Normal. <1.0 

- gliadin (deamidated) Ab (IgG). High. 209.2 U/mL. within high range greater than null.

(Value Interpretation ----- -------------- <15.0 Antibody not detected > or = 15.0 Antibody detected)

- immunoglobulin A. Normal. 303 mg/dL. within normal range between 47 and 310.

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trents Grand Master
trents
Posted

Welcome to the forum, phosphene!

DGP IGG is quite high! It is not borderline. It certainly can indicate celiac disease but the test is not as specific as the tTG-IGA for celiac disease.

One thing that can throw false negatives for the tTG-IGA is low total serum IGA but that test was not ordered.  It should have been. Another thing that can drive the tTG-IGA score downward is commencing a gluten free or lower gluten diet ahead of the blood draw.

Scott Adams Grand Master
Scott Adams
Posted

This article might be helpful. It breaks down each type of test, and what a positive results means in terms of the probability that you might have celiac disease:
 

Quote

The sensitivity of the DGP-IgG test is reported to range from 75% to 85%, which means it can correctly identify individuals with the condition in about 75% to 85% of cases. The specificity of the DGP-IgG test is reported to range from 75% to 95%, which means it can correctly identify individuals without the condition in about 75% to 95% of cases.

At this point your doctor should schedule an endoscopy to confirm celiac disease. If this test should end up negative I would still consider non-celiac gluten sensitivity.

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.

 

 

Russ H Community Regular
Russ H
Posted
14 hours ago, phosphene said:

I've been searching through this forum and online but haven't gotten a clear answer, so I thought I would post my results specifically. My understanding is that a high gliadin IgG isn't really enough for a diagnosis, but what does it mean?

You have isolated DGP-IgG. This is common in people who do not have coeliac disease and so by itself is not usefully predictive.

https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.16071

Scott Adams Grand Master
Scott Adams
Posted

The study referenced looks at 26 children, and many other larger studies have shown the overall accuracy I mentioned. The next step would likely be another biopsy, if that is what your doctor recommended. To do that you'd need to keep eating gluten daily until all testing is completed.

knitty kitty Grand Master
knitty kitty
Posted

This article refutes the article in the post left by @Russ H.

Can we ignore the utility of deamidated gliadin peptide in the diagnosis of celiac disease in children?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697416/

And another article about the value of the DGP IgG test...

Diagnostic accuracy of anti-DGP (IgG) for celiac disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071923/

 

  • 4 weeks later...
Russ H Community Regular
Russ H
Posted

These references do not refute the paper I posted.

The second reference, "Diagnostic accuracy of anti-DGP (IgG) for celiac disease", does not compare isolated anti-DGP with anti-tTG2. This is a common mistake - when both anti-DGP and anti-tTG2 are raised it indicates coeliac disease. However, isolated anti-DGP is not predictive of coeliac disease in adults.

The first reference is a letter to the journal. The authors do not state when the serum testing was performed - at diagnosis or on a gluten-free diet - and there is no control group, so cannot derive a positive predictive value. It is not uncommon to have raised anti-DGP in the general population: someone with coeliac disease without raised anti-tTG2 antibodies may indeed have raised anti-DGP antibodies but this is likely incidental and not caused by coeliac disease itself.

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frieze Community Regular
frieze
Posted
On 9/20/2023 at 1:33 AM, trents said:

Welcome to the forum, phosphene!

DGP IGG is quite high! It is not borderline. It certainly can indicate celiac disease but the test is not as specific as the tTG-IGA for celiac disease.

One thing that can throw false negatives for the tTG-IGA is low total serum IGA but that test was not ordered.  It should have been. Another thing that can drive the tTG-IGA score downward is commencing a gluten free or lower gluten diet ahead of the blood draw.

The last test listed is IGA

trents Grand Master
trents
Posted
1 hour ago, frieze said:

The last test listed is IGA

Yes, I see that now. Yours is not low.

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