Question about celiac test

faithberry · Post by **faithberry** » Thu Apr 23, 2009 6:51 am

Hi,

When I had a celiac disease blood test done at the end of last year, my Anti-Gliadin IgA (Multiplex) was elevated, but nothing else. Do you think this has any significance? From what I can gather so far, it's one of the less reliable indicators. At the same time, it's a bit weird that I am now having malabsorption of fat, which I didn't have when I was dx'd with MC several years ago. Also, I haven't eaten gluten for a few years, so I wonder why it would be elevated. Any thoughts?

Faith

Post by **tex** » Thu Apr 23, 2009 9:00 am

Hi Faith,

Researchers seem to have a lot of trouble correlating early markers of gluten-sensitivity with celiac disease and/or related issues. Presumably, that's probably the main reason why most doctors don't recognize any possibility of gluten-sensitivity, in any situation other than fully-developed celiac disease. IOW, they just can't seem to get their ducks in a row on this issue. You may find this article to be relevant:

http://www.ncbi.nlm.nih.gov/pubmed/17578801

Faith wrote:it's a bit weird that I am now having malabsorption of fat, which I didn't have when I was dx'd with MC several years ago. Also, I haven't eaten gluten for a few years, so I wonder why it would be elevated. Any thoughts?

Could the fat malabsorption have been masked by some other issue back then? Possibly, the test used for the determination of fat malabsorption was flawed, or just not sensitive enough. It's not uncommon to still show residual small intestinal damage several years after the exclusion of gluten from the diet - I had a fat malabsorption test done at Enterolab three years after adopting the diet, and it still showed residual damage.

If none of the above applies, then obviously, (unless you are accidentally ingesting small amounts of gluten), something else is going on. Fat malabsorption can also be caused by a variety of other issues, (such as giardia, or other parasites), mucosal disease, or bacterial overgrowth. A common cause is pancreatic insufficiency. Have you ever taken any of the 5-ASA meds? Asacol, especially, has been shown to post a risk of chronic pancreatitis for some patients. Usually, though, the pancreatic inflammation will subside after the medication is withdrawn. Of course, other issues with the pancreas can also cause this problem. Pancreatitis should normally be accompanied by pain, though, I would think.

Tex

faithberry · Post by **faithberry** » Sat Apr 25, 2009 7:42 am

Tex,

Thanks for your reply and help, as always your are terrific.

We found no increased frequency of verified coeliac disease in 89 patients with IgA-nephropathy. The findings suggest a possible link of celiac disease to IgA-nephropathy and a role for antibodies to food antigens in this disorder.

I gather from this article that there are other diseases associated with elevated antigliadin antibodies like IgA Nephropathy. But I don't understand this particular quote. They say they found no instance of celiac disease but conclude that there may be a link to celiac disease. Is this the point you are making, that it can be an early sign of celiac disease before it becomes full blown? Are you suggesting that the elevated antibodies I have could be an early sign of celiac? Are DQ1 genes ever associated with celiac?

I don't think I have this disease (basically, I don't need another disease please!). I want to look into gluten sensitive idiopathic neuropathy because I do get neuropathic pain and have been getting it in new spots in the last 6 months to one year. Now I just drink some water (even small amounts) and can get pain and hot flashes. It seems to relate to having too much stomach acid is what I guess. The water, obviously does not contain gluten!

Possibly, the test used for the determination of fat malabsorption was flawed, or just not sensitive enough

I did Dr. Fine's test and I was well within the normal level so I don't think the test was wrong and my poop didn't float then. I'm basing the current idea of fat malabsorption on the fact that my poop floats sometimes.

If none of the above applies, then obviously, (unless you are accidentally ingesting small amounts of gluten), something else is going on.

I've been eating a lot of organic brown rice. What do you think is the likelihood of cross-contamination? Has anyone else on the board had a problem with rice like this? I switched to white rice and have fewer problems, but then it's easier on the stomach acid too.

Fat malabsorption can also be caused by a variety of other issues, (such as giardia, or other parasites), mucosal disease, or bacterial overgrowth. A common cause is pancreatic insufficiency.

I don't think it's a pancreatic problem (no pain); my enzymes were better on my last CDSA than when I had it done before my MC dx. No parasites showed on last CDSA, but they can be hard to find. Checking for bacterial overgrowth is a good idea. What's mucosal disease?

Malabsorption is also a factor in mastocytosis, but I don't know what the mechanism is. Mastocytosis is considered a hypersecretory disease (too much stomach acid) and I wonder if excess acid getting into the SI could cause mucosal damage????

The Ac Anti Gliadin (Multiplex Fidis) antibodies aren't super high. They are 28 UA/ML and they are supposed to be under 15 UA/ml. Of course, the GI doctor just flew past this page saying, 'see you don't have celiac,' and he would probably just have attributed this to the fact that some normal people just happen to have these elevations sometimes.

Honestly, I don't know how doctors ever figure anything out! Everything is so interconnected and there are so many different possibilities. Sometimes I feel like I am going around in endless circles.

Thanks for any insights you have.

faithberry · Post by **faithberry** » Sat Apr 25, 2009 8:00 am

This was helpful...

en.wikipedia.org/wiki/Gluten-sensitive_idiopathic_neuropathies

Post by **tex** » Sat Apr 25, 2009 10:08 am

Faith,

First, I'll say that if your fat malabsorption test was done at Enterolab, then I see no reason to doubt the results. Their accuracy seems to be the best in the industry, by far. Also, note that Dr. Fine himself, considers gluten sensitivity, (as detected by stool tests, which are, as I recall IgA-based), to be a precursor of celiac disease, (as noted in his "Tip of The Iceberg" lecture). Many medical "experts" use rather sloppy syntax regarding gluten sensitivity. They equate it with celiac disease, (gluten sensitive enteropathy), but by definition, both celiac disease, and gluten sensitive enteropathy, are limited to a very narrow spectrum of histologic markers. Gluten sensitivity, on the other hand, covers a much broader spectrum of possible markers and symptoms. The medical community as a whole, seems unwilling to accept Dr. Fine's, (and other knowledgeable GI docs and researchers), observation that the definition of celiac disease is incorrectly restricted, and should be broadened to include all aspects of gluten sensitivity. Note that Dr. Fine has not come right out and specifically stated what I have written here, (not that I am aware of, anyway), but in essence, that's what his findings suggest.

As far as DQ1 genes being associated with celiac disease: Not so far as I am aware, but it is known that celiac disease can occur without the presence of DQ2 or DQ8 genes, so nothing is chiseled in stone, in this regard. We, (medical science) still have a lot to learn about genetics, obviously.

If you are basing your assumption of fat malabsorption, on floating stools, you might be jumping to an incorrect conclusion. There are other causes of floating stools.

9. Floating stools

Stools that float are generally associated with some degree of malabsorption of foods or excessive flatus/gas. Floating stool is seen is a variety of different situations, the majority being diet-related or in association with episodes of diarrhea caused by an acute gastrointestinal infection. A change in dietary habits can lead to an increase in the amount of gas produced by bacteria in the gastrointestinal tract. Similarly, acute gastrointestinal infections can result in increased air/gas content from rapid movement of food through the GI tract. One misconception is that floating stools are caused by an increase in the fat content of the stool. In fact, increased air/gas levels in the stool make it less dense and allow it to float. Another cause of floating stools is malabsorption. More than two weeks of diarrhea with floating stools is often seen in people suffering from malabsorption, a dysfunction in the GI tract that affects the body's ability to digest and absorb fat and other food. Increased levels of nutrients in the stool (those not absorbed by the GI tract) are supplied to the normal bacteria that live in the gut, which in turn produce more gas. This results in more air/gas- rich stool that floats. Dietary changes, diarrhea, and malabsorption can cause floating stools. Most causes are benign and will resolve when the infection ends or the bacteria in the GI tract become accustomed to the changes in your diet.

http://www.enzymestuff.com/rtstools.htm

Note that the last sentence in that quote implies that a bacterial imbalance or overgrowth, could be a possible cause, also.

Regarding your question about mucosal disease: Technically, mucosal disease is a virus that cattle get, but many in the medical community use the term broadly, to refer to various diseases that affect mucous membranes anywhere in the body. For example here's an index of some of those diseases of the upper GI tract:

http://www.maxillofacialcenter.com/Bond ... mucosa.htm

You're quite correct, of course, in that many conditions seem to have the same symptoms, and an analysis can go round and round, and just get more and more confusing, when we try to get to the root of the problem. Sometimes we have to look for subtle, unique clues, otherwise, we wind up flipping a coin. I have a hunch that in such a situation, most doctors just go with the old "when you hear hoofbeats" theory, and pick the most common diagnosis.

Tex

faithberry · Post by **faithberry** » Sun Apr 26, 2009 5:48 am

OK, it's probably just too much gas in them stools, not celiac disease, and probably connected to mast cell problem. Apparently, almost 20% of 'normal' people have elevated IgA. My body just doesn't like gliadin and the antibodies are ready to spring into action. The stools have been less floaty the last few days, so maybe I'm headed in a better direction.

Great, I definitely do not want to have celiac disease too! Thanks for the information.