Well... You may fall short of a positive anti-tTG by a little bit, but in terms of being in the gray zone... you are dark gray! Little doubt in my mind that you are gluten sensitive based upon your positive antigliadin IgA, IgG, and symptoms.... and an anti-tTG just shy of making the golden mark toward a celiac diagnosis.
I think you are on the right track, and my advice (I'm obviously not a doctor) would be to go gluten free based on the results thus far and never look back. I think there is a really good chance you'd see improvement in your symptoms. DO NOT BEGIN A GLUTEN FREE DIET IF YOU THINK YOU WANT TO HAVE A BIOPSY OR A FORMAL CELIAC DIAGNOSIS, because you need to be eating gluten through the entire diagnostic process.
I'm somewhat impressed your doctor said you probably have gluten sensitivity. Did he recommend a gluten free diet with that?
If you are one who really wants to shoot for a clear diagnosis (sometimes at the expense of your health)... you could...
1) Ask for a biopsy. I think there is at least a fair to good chance that you might show some degree of damage on biopsy (aka celiac disease). In the "olden" days, a positive antigliadin IgA earned one a biopsy. I think it still does!
A positive anti-tTG has a positive predictive rate of about 95% that they will find damage on biospy. A positive anti-gliadin IgA has a positive predictive rate of anywhere between 50-80% depending upon the study you read, sometimes higher. It's been a long time since I've looked at those stats, but I'll leave you some references.
A positive antigliadin IgA is more predictive of finding intestinal damage than a positive antigliadin IgG. I do think, if you are interested... you should ask for the biopsy. If you are happy to move to a gluten free diet and let the diet speak to you... go for it. That is how we approached it with my daughter, and based upon the results we've never looked back.
Check out this article and look for the algorithm that says a positive antigliadin IgA suggests a high probability for celiac disease.
http://www.aafp.org/afp/20021215/2259.html
I think most celiac experts would proceed to biopsy in any symptomatic patient with your blood test results. You could request that the anti-endomysial test be run as well because sometimes it is positive when the anti-tTG is not clearly positive.
2) Wait to get worse (which is basically what they usually ask of those who are symptomatic, but fall short of a clear celiac diagnosis), and retest your blood in another year. It would not be uncommon to turn positive at that point. I would not suggest waiting to get worse, but there are many doctors who would.
Quote:
We conclude that one-time testing for celiac disease among families with affected members is insufficient. Repeat testing should occur irrespective of the presence of symptoms.
Screening for Celiac Disease in Family Members: Is Follow-up Testing Necessary?
PMID: 17380406 April 2007
Among 11 relatives, at the time of the first screening, 6 already had a positive serology and histology for CD, while 5 became positive only after a period of 2 to 5 y of negative testing.
CD can manifest itself after years of negative serological testing
Also: Follow-Up to the Catassi Study -- Scandinavia
Colin, et al, published a follow-up study to the Catassi (Coeliac Disease in the Year 2000:Exploring the Iceberg - University of Ancona, Italy) in the Scandinavian Journal of Gastroenterology 28(7):595-8, 1993, which demonstrated that approximately one third of the patients from the Catassi Study who had raised antibodies but no villous atrophy, did have villous atrophy when tested two years later. These results raise the number of diagnosed celiacs from the Catassi, et al study to over 1 in 200.
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I would suggest reading through The Gluten File, in particular, these pages. Just a quick browse will give you some idea of the things you need to be thinking about in making a decision on how you would like to proceed. I have little doubt gluten is your enemy~ whether you'd show positive on biopsy or not.
Diagnostic Testing
Delay of Diagnosis (You wouldn't be the first to get the anxiety diagnosis. I think I got it, too, although not stated clear out. And, yes, all the symptoms I was exhibiting were anxiety promoting, but anxiety wasn't the problem.)
The Gray Zone
Genetic Testing
Limitations of Blood / Biopsy (Be sure to look for the studies that talk about seronegative celiac disease... I forgot to mention that up to 20% of biopsy proven celiacs have a negative anti-tTG. Your positive antigliadin IgA is really suggestive of celiac disease... I think you'll find the studies here to show that. A biopsy really is warranted, unless you are convinced to go gluten free for life without one.)
Antigliadin Antibodies
Gluten Sensitivity vs. Celiac Disease (I think a gluten free diet makes sense for you even if you have a negative biopsy, but it might be worthwhile to know if you actually have celiac disease... which should prompt testing of all blood relatives)
At Risk Population for Gluten Sensitivity/Celiac Disease
So... in summary... you could..
1) Commit to a gluten free diet based upon the results so far
2) Get a biopsy. You've earned it, and it could be positive
3) Request additional blood work... a positive anti-endomysial would be a clear indicator of celiac disease
4) Wait to get worse... and retest your blood again in a year.
I really don't recommend #4!
Cara