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Old 11-01-2007, 12:49 PM #1
borst borst is offline
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Question Interpreting celiac panel results

Hi, new member here.
I've been trying to tackle my health issues for about 4 years now with no definitive answer. This is my history that i typed up for my new physician that i'm seeing (trying to seek a second opinion). I tried to make it as concise as possible but i have a complicated history.
Quote:
2001
- Went to family doctor in with symptom of bright red blood on tissue.
- Had Upper GI series done
- Diagnosed with duodenal ulcer (even though there were no other visible symptoms)
- Underwent HP-PAC treatment
- Blood on tissue intermittantly after, did not think much of it
December 2004
- Came down with sinus infection
- Went to walk-in clinic, prescribed a week long dosage of antibiotics, ibuprofen and anti-inflammatory nasal spray
- During treatment, began having waking morning bowel urgency and loose stool. (this morning urgency has occurred daily without relief for 3 years)
- Blood on tissue became more frequent
- Saw doctor who performed digital exam and then referred to GI specialist to investigate the rectal bleeding.
- Before appointment with GI specialist, saw family doctor who decided to do another upper GI series. Also had liver function test, CBC, abdominal x-ray as well as Gastrin test. All came back normal.
- Found Gastric ulcer through Upper GI test, and put on HP-Pac again
- During treatment, had severe episode of diarrhea, lasting 2 days, could not keep any food down.
- Went to emergency room, given fecal collection kit to test for parasites.
- April 2005, had unexplained weight loss of at least 15 lbs.
- GI specialist in May 2005, underwent sigmoidoscopy, looked normal. Doctor suggested bleeding likely due to fissure. Did not address other gastro. concerns. Seemed dismissive
- Went back to family doctor who decided to order Lower GI series; result: colon was imaged well, and looked normal.
- Doctor began to suspect anxiety as probably cause.
April 2007
- Had a week long episode of stomach flu like symptoms, starting with slight fever, chills, and then week of diarrhea. Unable to eat much of anything.
- Mid April, during exams, started feeling off-balance when standing, slight lightheadedness. Has been constant with no pattern since then. Doctor ordered CBC, came back normal.
- During summer, had another episode of unexplained weight loss of more than 15lbs. Doctor ordered thyroid function test which came back normal. Again, attributed symptoms to likely anxiety issues.


Current symptoms/concerns:
- Continued daily episodes of morning bowel urgency, usually loose stools. Occasionally, there is first a semi-normal stool, followed minutes later by much looser/watery stools. Less frequently, there is visible large amounts of mucus. As well, colour and form of stool at times abnormal; sometimes very light, sometimes contains parts that are almost black. As well, appearance of undigested food present sometimes. Blood on toilet paper as well as streaked on stool frequent.
- Through out rest of day, there is instances of mild discomfort in abdomen, and under right ribcage.
- Constant feeling of off-balance when standing, sometimes severe, sometimes slight.
- Frequent episodes of sore radiating foot pain at night in bed, about 3-4 nights a week.
- Still unsure of reasons for episodes of unexplained weight loss.

Anyway, the first thing my new physician wanted to do was run some general bloodwork as well as a celiac panel. I got the results back today:

Quote:
Celiac Panel
- Gliadin IgA ABS = 26 (ref range: <20 KEU/L)
- Gliadin IgG ABS = 20 (ref range: <20 KEU/L)
- Transglutaminase IgA = 17
(under reference range it says <20 = negative, 20-25 = borderline, >25 = positive)
So my Glidin IgA is positive, my Gliadin IgG borderline, and my Transglutaminase IgA looks negative.
My doctor said I may have a gluten sensitivity but not "full blown Celiac". What do you guys think?


The rest of my bloodwork showed some spikes as well..
Quote:
- Magnesium = 1.08 (ref range: 0.65-1.05mmol/L)
- Sodium = 146 (ref range: 135-145)
- Potassium = 5.2 (ref range: 5.2)
- Hemoglobin = 174 (ref range: 135-170g/L)
- Hematocrit = 0.51 (ref range: 0.38-0.49 l/l)
- RBC = 5.82 (ref range: 4.2-5.70)
The bloodwork also included a random glucose test, calcium, vitamin b12, Ferriton, sTSH, T4 Free, Free T3, GGT, AST, Alkaline Phosphatase, all came back within normal range.



I'm getting a referral back to the same gastroenterologist that i had before, hopefully will get some more answers this time

Any advice/suggestions/insight would be appreciated.

Thanks
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Old 11-01-2007, 05:17 PM #2
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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.
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
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Last edited by jccgf; 11-02-2007 at 08:05 AM.
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Old 11-01-2007, 05:21 PM #3
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How could I forget? What was your "normal" B12 level? Also check The Gluten File, way bottom down on right bar, for a page on B12 deficiency and symptoms. A "normal" level shouldn't always pass.

B12 deficiency can cause some of the symptoms you describe... including bowel urgency, being off balance, foot pain, etc.

Hard to say if you are experiencing peripheral neuropathy or ataxia (possibly with foot pain, off balance)... but gluten sensitivity can also cause those things.

Also forgot to mention... mucous in the stool is a common finding in gluten sensitivity/celiac disease. Also is h. pylori.... there is a page on that in The Gluten File, too.

I'd call that GI doctor by telephone, and tell him your blood test results, and ask if he'd recommend a biopsy. If not... I'd probably look for a different doctor!

Cara
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Last edited by jccgf; 11-01-2007 at 05:52 PM.
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Old 11-01-2007, 06:27 PM #4
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Thanks for the great reply. My B12 was 344 with the reference range being:

- >150 = not b12 deficient
- 110 to 150 = possibly b12 deficient
- <110 = probably b12 deficient


I should have noted that im taking b12 supplement (in tongue strip form 1000mcg) and a b50 complex (pill form)
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Old 11-01-2007, 07:11 PM #5
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Old 11-01-2007, 10:12 PM #6
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That is the most interesting reference range I've seen for B12... so I am just confused!

I was 294 (150-1100) as range. They typically say anything under 400 is suspect for problems, and many of us who have had B12 problems aim for a level of about 1000.

But, no matter the confusion of range, I'm happy to hear you are taking 1000mcg daily. I'd stay with that....forever!
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Old 11-02-2007, 06:20 AM #7
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Default Given your celiac panel test results--

--that B12 level certainly adds weight to the argument that you have gastric malabsorption, even if you would not currently rise to the level of "biopsy proven flattened villi gold standard celiac".

Vitamin and mineral malabsorption/deficiency are very common in gluten sensitivity/celiac (I wonder what your Vitamin D and calcium/magnesium/potassium levels are), though, of course, there are many possible causes of such malabsorption/deficiency. They may all be ultimately related to too much intestinal permeability (Google: "zonulin" if you want to read about the cutting edge of research/theory here).

I don't think any of us would think a B12 levle of 344 is "normal"--especially if you received that result after starting to take supplements (what kind are you taking, by the way?). Most of us believe the serum B12 can be a misleading/incomplete test--people have symptoms of deficiency even into the 500's/600's at times--but the ranges you quoteed are WAY outdated. In Japan and many parts of Europe, the low end of the range starts at 500-550, and there is no uppler limit. Most of us strive for four-figure serum concentration numbers to make sure our tissues are at least well-bathed in B12.

You should definitely take a look at Rose's B12 site:

http://roseannster.googlepages.com/home


--and anything Mrs. D has written about vitamin/mineral deficiency; in fact, our vitamin/supplement forum is a good place to go:

http://neurotalk.psychcentral.com/forumdisplay.php?f=49
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Old 11-02-2007, 07:38 AM #8
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Thanks for the reply..

My Magnesium level was actually higher than normal
it was 1.08 with reference range of .65 - 1.05
potassium was also high at 5.2 with ref range of 3.3-5.1
sodium was high at 146 with ref range of 135-145.
calcium was 2.40 with 2.2-2.65 as ref range

So im not sure what those high levels mean, doctor said i might have been a bit dehydrated?



Quote:
Originally Posted by glenntaj View Post
--that B12 level certainly adds weight to the argument that you have gastric malabsorption, even if you would not currently rise to the level of "biopsy proven flattened villi gold standard celiac".

Vitamin and mineral malabsorption/deficiency are very common in gluten sensitivity/celiac (I wonder what your Vitamin D and calcium/magnesium/potassium levels are), though, of course, there are many possible causes of such malabsorption/deficiency. They may all be ultimately related to too much intestinal permeability (Google: "zonulin" if you want to read about the cutting edge of research/theory here).

I don't think any of us would think a B12 levle of 344 is "normal"--especially if you received that result after starting to take supplements (what kind are you taking, by the way?). Most of us believe the serum B12 can be a misleading/incomplete test--people have symptoms of deficiency even into the 500's/600's at times--but the ranges you quoteed are WAY outdated. In Japan and many parts of Europe, the low end of the range starts at 500-550, and there is no uppler limit. Most of us strive for four-figure serum concentration numbers to make sure our tissues are at least well-bathed in B12.

You should definitely take a look at Rose's B12 site:

http://roseannster.googlepages.com/home


--and anything Mrs. D has written about vitamin/mineral deficiency; in fact, our vitamin/supplement forum is a good place to go:

http://neurotalk.psychcentral.com/forumdisplay.php?f=49
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Old 11-02-2007, 07:41 AM #9
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I am taking Jamison brand b12 strips

http://www.jamiesonvitamins.com/en/p...amins_182.aspx

and Jamieson b50 complex

http://www.jamiesonvitamins.com/en/p...amins_167.aspx
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Old 11-02-2007, 05:05 PM #10
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Default Dehydration is certainly one explanation--

--for high serum electrolytes, but here are many others, perhaps related to gluten and perhaps not.

First thing to check might be whether the test stood around too long--often, there is leakage of potassium/magnesium from ruptured blood cells into serum--the more time, the greater the leakage--and this skews the measured results. (The more accurate test, especially for potassium, is to measure pure plasma originally.) Also, high blood acids such as are found in diabetes and kidney dyfunction can produce elevated levels. And many medications play havoc with these ions.

But, your results are not WAY out of range--they're close enough to the reference range so that the tests should in all likelihood be repeated. A 24-hour urine test, to see how your kidneys are handling things, would probably also be a good idea.

The supplements seem innocent enough--though I was not able to determine the form of the B12 or the other B's from the links (most of us like the easier to metabolize methylcobalamin B12 rather than the cyanocobalamin in most commercial preparations, and the P-5-P coenzymated form of B6 rather than straight pyridoxine).

Where are you currently being treated (e.g., where were the tests ordered from, and through)?

Last edited by glenntaj; 11-03-2007 at 06:31 AM.
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