Guidance on next steps after the lab tests

[ABP2025]

In addition to regular lipid blood tests, I took some celiac tests last eeek and these are the results:

1. Celiac - Deamidated Gliadin IgG - 34.5 U/mL - Above range 

2. Celiac - Deamidated Gliadin IgA - <1.0  - Normal

3. Celiac - Tissue Transglutaminase IgG - <1.0  - Normal

4. Celiac - Tissue Transglutaminase IgA - <1.0  - Normal

5. Immunoglobulin A IgA - 143 mg/dL - Normal

What does the above results mean? What next steps can I take to diagnose if I have celiac or NCGS or something else?

[trents]

Was the blood draw made while you were still consuming regular amounts of gluten and had been doing so for at least a period of months? Getting blood antibody tests after already having embarked on a gluten free diet or even limiting gluten consumption will invalidate testing.

Edited 13 hours ago by trents

[ABP2025]

I would say I wasn’t on a gluten free diet but I’m not sure if I was consuming enough gluten before I took the tests. How long should I be consciously including gluten in my diet before I take the test?

4 hours ago, trents said:

Was the blood draw made while you were still consuming regular amounts of gluten and had been doing so for at least a period of months? Getting blood antibody tests after already having embarked on a gluten free diet or even limiting gluten consumption will invalidate testing.

I would say I wasn’t on a gluten free diet but I’m not sure if I was consuming enough gluten before I took the tests. How long should I be consciously including gluten in my diet before I take the test?

[trents]

Most recent guidelines recommend at least 10g of gluten daily for at least 2 weeks daily leading up to the day of the test. 10g of gluten is roughly the amount found in 4-6 slices of wheat bread. Personally, to be sure you will produce valid test results I would extend the "gluten trial" period from two weeks to four weeks.

[Scott Adams]

It looks like you had a positive blood test for celiac disease, so the next step could be an endoscopy to confirm celiac disease. 

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. 

 

 

[trents]

From your first post, tests 1-4 are individual antibody tests used to detect celiac disease. #5 is what we call "total IGA" which is used to check for IGA deficiency. If a person is IGA deficient, it can skew their individual IGA test scores down toward the negative range and generate false negatives. You are not IGA deficient. Test #4 from your first post, the tTG-IGA, is the most popular test ordered by physicians and considered to be the best single test for diagnosing celiac disease. It is relatively inexpensive to run and it combines excellent specificity with excellent reliability. You were negative for this one. The reason could have been, however, that you had been eating a reduced gluten diet. The one positive test you had, the DGP-IGG, is not as specific for celiac disease as is the tTG-IGA but certainly can indicate that you do have celiac disease, particularly if you were skimping on gluten when the blood draw was done.

The endoscopy with biopsy of the small bowel lining is considered to be the gold standard of diagnostics for celiac disease. But it still requires that you have been eating generous amounts of gluten for weeks/months to be valid. Otherwise, the villous lining begins to heal and nothing shows from the biopsy. The problem might be finding a GI doc willing to do an endoscopy/biopsy on the elevated DGP-IGG alone. He/she may want to repeat the antibody panel first.

Your other option is to forego an official celiac diagnosis and commit to seriously eating gluten free and see if your symptoms improve. You would not know whether you have celiac disease or NCGS but the antidote for either is the same.

You never mentioned your symptoms. What led you to get tested for celiac disease?