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Forum Name: Gastroenterology Topics

Question: Interpreting celiac panel results


 borst - Sun Nov 11, 2007 11:49 pm

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.
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.
- Also recently, been having episodes of urges to burp after eating, with slight pain in upper right chest area when doing so, indigestion?



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:

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..
- 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
 Dr. Chan Lowe - Tue Nov 13, 2007 10:57 pm

User avatar Hi Borst,

The antibody panel for celiac disease only provides supporting or contrary evidence for the disease. It generally should not be used to make the diagnosis. If, however, you have all the symptoms and have positive antibodies it makes the disease much more likely. Formal diagnosis is best made by doing an endoscopy and biopsying the small intestine to see if it looks inflamed and consistent with celiac disease.

Your symptoms may be consistent with celiac disease. They may also be consistent with irritable bowel disease. It may be worth a trial of a gluten free diet to see if your symptoms get better. If they do this would support celiac disease also. I would recommend that you follow up with a GI specialist for further evaluation of this.

Best wishes.
 borst - Wed Nov 14, 2007 1:23 pm

Thank you Doctor
I assume when you say Irritable Bowel Disease, you mean Inflammatory Bowel Disease? Are there usually differential symptoms between Celiac and IBD?

Also I was also concerned about kidney function.
My Creatinine level was 111 μmol/l which was one unit over the reference high range of 110 which gave me an eGFR of 76. Also my elevated electrolyte levels (sodium potassium) and magnesium, although only slightly above normal were of concern. My doctor mentioned these could have been just from me being slightly dehydrated at the time.

Any insight would be appreciated.

Dr. Chan Lowe wrote:Hi Borst,

The antibody panel for celiac disease only provides supporting or contrary evidence for the disease. It generally should not be used to make the diagnosis. If, however, you have all the symptoms and have positive antibodies it makes the disease much more likely. Formal diagnosis is best made by doing an endoscopy and biopsying the small intestine to see if it looks inflamed and consistent with celiac disease.

Your symptoms may be consistent with celiac disease. They may also be consistent with irritable bowel disease. It may be worth a trial of a gluten free diet to see if your symptoms get better. If they do this would support celiac disease also. I would recommend that you follow up with a GI specialist for further evaluation of this.

Best wishes.

 Dr. Chan Lowe - Thu Nov 15, 2007 1:09 am

User avatar Hi again,

Celiac disease and inflammatory bowel disease are two distinct issues. Inflammatory bowel disease includes both ulcerative colitis and Crohn's disease. All three are antibody mediated diseases, though.

In my previous post I was actually thinking more of irritable bowel syndrome (IBS). I mistakenly referred to this as irritable bowel disease, a name by which it really isn't known. Sorry for any confusion.

The creatinine issue may very well have been due to some mild dehydration. It may also simply have been a normal value that had some variation based on the lab technique. Being one point over the upper limits is still basically normal.

Best wishes.

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