Root cause, Celiac or something else?

[jajus100]

Hi,

I started getting diarrhea and loose stools over three months ago. I also get some pain in my upper middle abdomen. I originally saw my doctor, and she ran tests for parasites, general blood tests, and celiac--which is what she suspected.

Stool test was negative for parasites, but showed rare white blood cells.
Celiac tests
antigliadin ABS, IGA = 0 where 0-4 was negative
Transglutaminase IGA = 1 Where 0-3 negative
Antigliadin ABS IgG = 21 where >9 was positive, so that one was a strong positive.

On the blood tests, the only ones that were highlighted were:

Neutrophils 74.5% H
Lumphocytes 18.3 % L
Bun/CR 11 L (12-20)
Globulin 2.4 L (2.7-4.3)

Was sent to the gastroenterologist where he did upper series barium test to show small bowel issues. That came out fine.

Did 3 day stool fecal fat--horrid test!!. It showed 15.4 where nomal was considered (0-6) They said this showed malabsorption.

Now the doctor wants to run TSH, which I already had done in September. It is normal, as I am on Thyroid medicine. Levoxyl at 75 MCG. TSH in September was 1.42 where the range was (.5-6.0)

I had never heard of Celiac until I was tested for it, but it said that sometimes Celiacs have IGA deficiency, thus some of the IGA tests will show false negatives. The gastro for some reason doesn't think a total serum IGA is necessary, though I don't know why. Should I still be concerned about celiac? Should I worry that the IGG test was positive even though I know it isn't specific for celiac. Should I still worry about my body making these antibodies. If not celiac, then what?

What is causing the diarrhea. More importantly, what is making me so damn tired all the time. I am a 43 year old white female.

[Kevin Pho, MD]

The IgG antibodies are not as sensitive nor specific as the IgA antibodies.  The IgG antibodies have a sensitivity of 75 to 85 percent and a specificity of 75 to 90 percent.

With a negative IgA antibody, it may be possible that the IgG antibody results were a false positive.  

Malabsorption, inflammatory bowel disease, or irritable bowel disease can all lead to chronic diarrhea.  I would consider a colonoscopy for further evaluation.  

To treat the malabsorption, further tests can be considered to determine what is not being absorbed.  Dietary changes can be considered to help alleviate the symptoms.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[maddy1001]

For information on Celiac Disease from patients and medical professionals, I go on the website www.delphiforums.com.
I was tested and all my tests came back negative but I'm now on a gluten-free diet because I feel better.  Sometimes you can be sensitive to the gluten without actually having CD.  Also, pick up a book titled "Dangerous Grains".  It's written by a doctor and a nutritionist who both have the disease?(or maybe one has the disease and the other has a family member with it - my memory's lousy today)  It's a well written, concise explanation of CD, it's symptoms and diagnoses etc.  
I would also suggest www.celiac.com
Good luck.

[jajus100]

Maddy,

Thanks for the information!  I did just get the book Dangerous Grains, but haven't had a chance to read it yet...

Dr.,

What is irritable bowel disease?  Is that the same as irrigable bowel syndrome?  They told me that it wasn't that since the fecal fat value was so high, and I had problems at night as well.  My real question was about IGA deficiency.  I called the Celiac hotline which is part of the Celiac center at Chicago University.  They said that if the antigliadin IGA is zero, it is a red flag for IGA deficiency...  They told me I should have the Ttg IgG test done.

[Dixie Gal]

Hi!   Learning to deal with celiac disease myself.   My MD considers it one root cause of MS.   One thing I've learned extremely important is rebuilding the gut flora by use of probiotics in large doses (acidophilos, bifidus, etc.).    Many good brands, one mark of good product is constant refrigeration during shipping/transport from source to store to home.   They deteriorate at room temperature.   I use JarroDophilus & Natren,

Once the celiac disease has made the gut permeable, molecules can cross the blood barriers and make a person autoimmune.   Going on the celiac diet is imperative, but rebuilding the gut is as important.    Doctor says one bit of grain affects the immune system for three months, so important to stay with it.

Antibiotics destroy the good bacteria and wreak havoc, often the trigger.

Along with celiac info, check out gut permeability, probiotics, etc. to get things on the right track.

Hope this helps.

[Little Dogie]

Hi,  Recently had endoscopy of small bowel and the biopsy confirmed Celiac.  They have sent the serological testing Blood work to a fancy lab in CA and it did not support Celiac.  The story goes that only a biopsy may show it.  It will certainly be worth it to you to know for sure.
Don't mess around for years and many Doctors and test and I've been tired and sick all my life. My heath has been close to death when this may have been un-necessary.  I just wish I'd had someone to advise me.
I've had excellent Doctors, but no one mentioned this.  If anemia hadn't been detected, maybe I would not have had gone through all the joint pains, muscle spasms and so much more.
I'm new at this myself and learning to contol the gluten-wheat intolerance.  My iron is finally up, but I am still without any energy.  My Gasto doctor says until my body starts absorbing it's nutrient my immune system will not heal.  I'm not sure I believe this, but I eat well and bowels are the best they heve been in years.  Health Food Store expensive, but worth it.  Good luck and don't wait as many years a I did messing around.  It can lead to Lymnoma and another cancer.  Good Luck and I hope it turns out negative if you do this.  It's a very easy test and you don't even know it.  Little Dogie