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Tex I had my post colonoscopy & pill cam GI doc visit to discuss recent blood work and medication choices. One interesting piece of the blood work came back that I do not understand. When a celiac panel was run I did not have the definitive pattern for the celiac disease, but he was a bit puzzled at the AGA Igg level being quite high... It measured 684 where the normal is supposed to be below 55. My GI doc was not sure how to interpret this in light of the other markers coming back negative. My take is the markers (Igg mediated) for Anti Giladian Antibodies (AGA) are significantly elavated - basically meaning that I have a reaction to gluten that can be measured on the blood.
Does this make sense Tex??
I should note I was given a gluten solution to drink 1 day prior to the test as I have been GF for several months, this was needed to be able to judge the bodies reaction. No fun by the way.
--Joe
Paging Tex
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Joefnh
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Paging Tex
Joe
Joe,Joe wrote:he was a bit puzzled at the AGA Igg level being quite high... It measured 684 where the normal is supposed to be below 55. My GI doc was not sure how to interpret this in light of the other markers coming back negative. My take there are the markers (Igg mediated) for Anti Giladian Antibodies (AGA) - basically meaning that I have a reaction to gluten that can be measured on the blood. Does this make sense??
I'm certainly no expert on IgG reactions, but my understanding is that IgG antibodies are predominantly involved in secondary immune response. IOW, their presence generally corresponds to a maturation of the antibody response. In view of that, I doubt that drinking that solution 1 day before the test, significantly affected your IgG level on the test, but I could be wrong, of course.
I'm wondering about the units of your test results. A normal range for human IgG is usually listed at around 565–1765 mg/dL, or, (5.65–17.65 g/L), of course, it's possible that the lab your doctor used, may use different units, or the test may involve a different "normal" range.
IgG antibodies are very important in fighting bacterial, viral, and fungal infections. A high IgG level typically indicates the presence of a long-term (chronic), infection. It can also be an indication of autoimmune issues such as graves disease, (hyperthroidism), or myasthenia gravis, for example. Has your thyroid function been checked lately? The most frequently noted initial symptom of myasthenia gravis is extreme fatigue, and indicators such as eye muscle weakness, especially drooping eyelids.
Anyway, if your IgG level is indeed high, then it should be checked out, and a treatment with an antibiotic might be in order. I would suspect that the most likely possibility is a chronic infection. I have no idea whether Crohn's disease normally causes an increase in IgG levels. I have to get back to work, so I don't have time to look that up, but you might check out that possibility.
Those are just preliminary remarks, of course, and subject to the results of additional tests.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hi Rich,
I will copy some Wikipedia info that may be helpful. It states that the AGA IgG is normally under 10, so perhaps the lab that analyzed your test is using a higher baseline (55). I agree with your statement that you definitely have a reaction to gluten that can be measured in the blood. Your classic celiac BLOOD test for AGA IgG is positive. Recall that most of us have a negative AGA IgG blood test, and that's why we need Dr. Fine's stool tests - to find the AGAs before they get into the bloodstream. Did you have endoscopy done (biopsy of the small intestine)??? I don't remember.
from Wiki: descriptions of the types of antibodies tested:
Anti-gliadin IgA
This antibody is found in ~80% of patients with coeliac disease. It is also found in a number of patients who are not enteropathic. Some of these patients may have neuropathies that respond favorably to a gluten elimination diet. This is referred to as gluten-sensitive idiopathic neuropathy. Clinically these antibodies and IgG antibodies to gliadin are abbreviated as AGA.
Anti-gliadin IgG
The IgG antibody is similar to AGA IgA, but is found at higher levels in patients with the IgA-less phenotype. It is also associated with coeliac disease and idiopathic gluten sensitivity. Anti-gliadin antibodies are frequently found with anti-transglutaminase antibodies.
Anti-gliadin IgE
The IgE antibodies are more typically found in allergy-related conditions such as urticaria, asthma, and wheat-dependent exercise-induced anaphylaxis.
Here is an interesting chart showing the loss of Anti-gliadin antibodies on the GF diet over time.
Days on GF diet AGA
0 ....................................203
7 (1 wk)........................... 195
30 (1 mo.)........................ 171
61 (2 mo.)........................ 144
91 (3 mo)......................... 121
122 (4 mo)........................ 101
183 (6 mo)......................... 72
274 (9 mo)......................... 44
365 (1 yr).......................... 27
548 (18 mo)........................ 11
730 (2 yr)........................... 6
AGA values below 10 (black) are normal
What is the relationship of gluten and anti-gliadin antibodies?. In gluten-sensitive individuals AGA testing is a routinely used blood test for possible presence of coeliac disease, allergies or idiopathic phenomena. The measurement of AGA is done with ELISA or radioimmunoassay. Such tests measure the level of AGA relative to a standard, such as a level of 10 = point which 85% of normal population falls below. Greater than 10 equals disease and a value of 3 is expected (mean).
Individuals who have coeliac disease may have values in excess of 200. There is the common expectation that removal of gluten results in the loss of AGA; however, since gluten is the target of the antibodies, that which would deplete them from the body, removal of gluten results in the benign circulation of antibodies. The half life of these antibodies is typically 120 days. Given an expected normal of 3 and assuming that the individual starts with a score of 203, we can predict the levels of AGA at various future time points. Based on these initial numbers, patients with very high AGA values may take 2 years to return to the normal range.
Refractory coeliac diease (RCD). RCD or non-strict gluten-free diet are two causes of failure of AGA to return to normality on the GF diet. In the first instance lymphocytes may remain stimulated even though the antigen that originally stimulated them was removed from the diet.
CLEAR AS MUD, HUH?
Love,
Polly
I will copy some Wikipedia info that may be helpful. It states that the AGA IgG is normally under 10, so perhaps the lab that analyzed your test is using a higher baseline (55). I agree with your statement that you definitely have a reaction to gluten that can be measured in the blood. Your classic celiac BLOOD test for AGA IgG is positive. Recall that most of us have a negative AGA IgG blood test, and that's why we need Dr. Fine's stool tests - to find the AGAs before they get into the bloodstream. Did you have endoscopy done (biopsy of the small intestine)??? I don't remember.
from Wiki: descriptions of the types of antibodies tested:
Anti-gliadin IgA
This antibody is found in ~80% of patients with coeliac disease. It is also found in a number of patients who are not enteropathic. Some of these patients may have neuropathies that respond favorably to a gluten elimination diet. This is referred to as gluten-sensitive idiopathic neuropathy. Clinically these antibodies and IgG antibodies to gliadin are abbreviated as AGA.
Anti-gliadin IgG
The IgG antibody is similar to AGA IgA, but is found at higher levels in patients with the IgA-less phenotype. It is also associated with coeliac disease and idiopathic gluten sensitivity. Anti-gliadin antibodies are frequently found with anti-transglutaminase antibodies.
Anti-gliadin IgE
The IgE antibodies are more typically found in allergy-related conditions such as urticaria, asthma, and wheat-dependent exercise-induced anaphylaxis.
Here is an interesting chart showing the loss of Anti-gliadin antibodies on the GF diet over time.
Days on GF diet AGA
0 ....................................203
7 (1 wk)........................... 195
30 (1 mo.)........................ 171
61 (2 mo.)........................ 144
91 (3 mo)......................... 121
122 (4 mo)........................ 101
183 (6 mo)......................... 72
274 (9 mo)......................... 44
365 (1 yr).......................... 27
548 (18 mo)........................ 11
730 (2 yr)........................... 6
AGA values below 10 (black) are normal
What is the relationship of gluten and anti-gliadin antibodies?. In gluten-sensitive individuals AGA testing is a routinely used blood test for possible presence of coeliac disease, allergies or idiopathic phenomena. The measurement of AGA is done with ELISA or radioimmunoassay. Such tests measure the level of AGA relative to a standard, such as a level of 10 = point which 85% of normal population falls below. Greater than 10 equals disease and a value of 3 is expected (mean).
Individuals who have coeliac disease may have values in excess of 200. There is the common expectation that removal of gluten results in the loss of AGA; however, since gluten is the target of the antibodies, that which would deplete them from the body, removal of gluten results in the benign circulation of antibodies. The half life of these antibodies is typically 120 days. Given an expected normal of 3 and assuming that the individual starts with a score of 203, we can predict the levels of AGA at various future time points. Based on these initial numbers, patients with very high AGA values may take 2 years to return to the normal range.
Refractory coeliac diease (RCD). RCD or non-strict gluten-free diet are two causes of failure of AGA to return to normality on the GF diet. In the first instance lymphocytes may remain stimulated even though the antigen that originally stimulated them was removed from the diet.
CLEAR AS MUD, HUH?
Love,
Polly
Blessed are they who can laugh at themselves, for they shall never cease to be amused.
Joe,
Didn't you imply that your AGA IgA test result was negative? I also assumed that you're saying that your anti-tissue transglutaminase antibody results, and your anti-endomysial antibody test results, were normal/negative. Right?
I have to agree with your GI doc. Unless you're IgA deficient, I don't see how the elevated IgG results could implicate a celiac reaction, in view of a negative IgA result. IgA is the one that should be elevated, with gluten-sensitive enteropathy. (Unless, of course, you're IgA deficient).
Tex
Didn't you imply that your AGA IgA test result was negative? I also assumed that you're saying that your anti-tissue transglutaminase antibody results, and your anti-endomysial antibody test results, were normal/negative. Right?
I have to agree with your GI doc. Unless you're IgA deficient, I don't see how the elevated IgG results could implicate a celiac reaction, in view of a negative IgA result. IgA is the one that should be elevated, with gluten-sensitive enteropathy. (Unless, of course, you're IgA deficient).
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Joe, I asked about endoscopy, but D'uh, was forgetting that you have active and increasing inflammation from Crohn's in your small intestine (jejunum). Serious inflammation like that would certainly lead to the antibodies getting directly into the bloodstream, in large numbers I would guess.
Yes, as Tex asked, I would like to know which specific test (markers) were negative.
I did find this:
According to the American Celiac Disease Alliance:
If a patient’s celiac panel is only positive for antigliadin IgG, this is not highly suggestive for CELIAC DISEASE if the patient has a normal total IgA level, corrected for age. Younger children make less IgA than older children and adults. A markedly elevated antigliadin IgG, such as greater than three to four times the upper limit of normal for that lab, is highly suggestive of a condition where the gut is leakier to gluten. This can happen in food allergies, cystic fibrosis, parasitic infections, Crohn’s disease, and other types of autoimmune GI diseases. These antibodies may also be slightly elevated in individuals with no obvious disease. (red emphasis mine).
Polly
Yes, as Tex asked, I would like to know which specific test (markers) were negative.
I did find this:
According to the American Celiac Disease Alliance:
If a patient’s celiac panel is only positive for antigliadin IgG, this is not highly suggestive for CELIAC DISEASE if the patient has a normal total IgA level, corrected for age. Younger children make less IgA than older children and adults. A markedly elevated antigliadin IgG, such as greater than three to four times the upper limit of normal for that lab, is highly suggestive of a condition where the gut is leakier to gluten. This can happen in food allergies, cystic fibrosis, parasitic infections, Crohn’s disease, and other types of autoimmune GI diseases. These antibodies may also be slightly elevated in individuals with no obvious disease. (red emphasis mine).
Polly
Blessed are they who can laugh at themselves, for they shall never cease to be amused.
Joe,
This reference appears to support Polly's latest post:
Tex
This reference appears to support Polly's latest post:
http://www.ncbi.nlm.nih.gov/pubmed/17924999The data are consistent with either a mucosal defect that facilitates increased exposure to microbial antigens or an altered immune response, both of which could occur due to known genetic and molecular defects in Crohn's disease.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Joefnh
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- Joined: Wed Apr 21, 2010 8:25 pm
- Location: Southern New Hampshire
Thanks Tex & Polly. this was the only one of 4 reported items on the 'standard celiac' blood test. I do not remember the other 3 but they were will within the normal limits.
Polly do you feel that the AGA number being quite high is due solely to the Crohns or is this really an indicator of a gluten reaction
--Joe
Polly do you feel that the AGA number being quite high is due solely to the Crohns or is this really an indicator of a gluten reaction
--Joe
Joe
AHA, Tex, I think we figured it out! 
It's always a pleasure putting our 2 heads together. But wouldn't you think a GI doc would know that this is possible with Crohn's, since that is supposed to be one of the areas of his/her exertise?
Joe, I would guess mostly the Crohn's but can't rule out both - you are at risk for a double whammy due to the Crohn's and the MC. "Whammy" - don't you just love my medical terminology? LOL.
Love,
Polly
It's always a pleasure putting our 2 heads together. But wouldn't you think a GI doc would know that this is possible with Crohn's, since that is supposed to be one of the areas of his/her exertise?Joe, I would guess mostly the Crohn's but can't rule out both - you are at risk for a double whammy due to the Crohn's and the MC. "Whammy" - don't you just love my medical terminology? LOL.
Love,
Polly
Blessed are they who can laugh at themselves, for they shall never cease to be amused.
Well, yes, but I would also think that a GI doc would realize that just because non-celiac gluten sensitivity has not been scientifically proven, does not provide proof that it cannot be true. Obviously, what I think has nothing to do with what GI docs think.Polly wrote:But wouldn't you think a GI doc would know that this is possible with Crohn's, since that is supposed to be one of the areas of his/her exertise?
Love,
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Joe,
FWIW, I agree with Polly that the IgG response is probably connected with Crohn's, (especially since your Crohn's has been in an active phase, recently), but it also may have a residual gluten response component left over from your initial antibody level, (the slowly-decaying residual of the level that may have been present before you started the GF diet). I still think that the AGA IgG result was not affected by the solution you drank the day before the test, though, since your AGA IgA level did not appear to respond to that drink.
Tex
FWIW, I agree with Polly that the IgG response is probably connected with Crohn's, (especially since your Crohn's has been in an active phase, recently), but it also may have a residual gluten response component left over from your initial antibody level, (the slowly-decaying residual of the level that may have been present before you started the GF diet). I still think that the AGA IgG result was not affected by the solution you drank the day before the test, though, since your AGA IgA level did not appear to respond to that drink.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Joe,
I assume that you realize that we're not implying that you're not sensitive to gluten - I'm simply saying that the test result that you inquired about, doesn't appear to indicate a positive response. That's not surprising, since we've maintained all along, that the blood tests are pretty much worthless for anyone who doesn't have fully-developed celiac disease.
Tex
I assume that you realize that we're not implying that you're not sensitive to gluten - I'm simply saying that the test result that you inquired about, doesn't appear to indicate a positive response. That's not surprising, since we've maintained all along, that the blood tests are pretty much worthless for anyone who doesn't have fully-developed celiac disease.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Joefnh
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- Joined: Wed Apr 21, 2010 8:25 pm
- Location: Southern New Hampshire
I was able to follow the exchange - slowly. It's great when you 2 start "talking shop" as it were. As I told my GI doc today whether the blood tests showed it or not, I am not eating gluten anymore...
I should mention Tex that he was quite appreciative of the articles on non-celiac gluten sensitivity articles I gave him, which were from you and others on this board. Thanks again
--Joe
I should mention Tex that he was quite appreciative of the articles on non-celiac gluten sensitivity articles I gave him, which were from you and others on this board. Thanks again
--Joe
Joe
Great! You may have planted the seeds that could bear fruit for many of his future patients. Good for you, and good for him.Joe wrote:I should mention Tex that he was quite appreciative of the articles on non-celiac gluten sensitivity articles I gave him, which were from you and others on this board. Thanks again
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.