Interpreting blood/biopsy results

[bobj]

Hello, I'm new to the forum. I don't know if I have celiac/gluten intolerance and am seeking advice on interpreting my test results.

I'm a 38 y-o male and was diagnosed with B12 deficient anaemia last October.

I've had an Esophago-Gastro-Duodenoscopy (EGD) and a colonoscopy, and biopsies. My biopsy results showed:

Mild chronic ileitis with slightly flattened mucosa in the lamina propia, terminal ileum (with no increased eosinophils or parasites seen).

Moderate or mild mononuclear cells in the antrum, body and incisura. No H pylori organisms identified.

Moderate intestinal metaplasia in the antrum.

The results were all fine and did not indicate celiac disease, according to my doctor (who wasn't able to give me any explanation for my B12 deficiency or for the "slightly flattened mucosa".)

Recently, I had celiac blood tests done. The results:

Anti-endomysial IgA - negative
Gliadin Peptides IgA - 2 RU/ml (normal range: 0-25 RU/ml)
Gliadin Peptides IgG - 109 (normal range: 0-25 RU/ml)

I was also tested for Intrinsic Factor antibodies and Parietal Cell antibodies (to test for pernicious anaemia, a cause of B12 deficiency) but was negative for both.

My doctor told me that the tests rule out celiac disease. He couldn't offer any explanation for why my Gliadin IgG result was so high - more than four times the upper normal range.

My symptoms have been fatigue/lethargy (which is why I was first checked for Vitamin B12). I had B12 shots and was taking B12 sublinguals but have had no noticeable increase in energy. Other symptoms have been short term memory loss and some other cognitive symptoms (lack of clarity, generally feeling slow mentally, thinking one word but saying another); depression and anxiety; psoriasis and eczema (pre-existing for years); thirst/dry mouth; thinning hair. Previously I had some tingling and numbness in the extremities but this has stopped.

Possibly relevant past history: I had gastro-intestinal symptoms for several years when aged in my early 20s and was diagnosed with Irritable Bowel Syndrome then. The symptoms later stopped. I don't have any gastro symptoms now.

My main questions are: what does it mean to have a very elevated Gliadin IgG result with a normal Gliadin IgA result?; and does a "slightly flattened" mucosa indicate celiac/gluten intolerance or may there be other explanations for this? Any advice or ideas on these or any other of my test results would be much appreciated.

[the sensible celiac]

When my biopsy was done I also had only slightly flattened villi, and B12 deficiency was the original cause for investigating my gut too.  I did not have the classic digestive symptoms so often associated with celiac disease. I certainly do have it because my daughter was unambiguously diagnosed with CD and we both have responded to the gluten free diet.

The elevated anti-gliadin IgG is not specific for celiac disease, but it is likely to indicate some sort of a reaction going on in your body to gluten.

Here is a quote about elevated  gliadin IgG results

IgG anti-gliadin antibodies have been the best diagnostic marker in the neurological population we have studied. IgG anti-gliadin antibodies have a very high sensitivity for CD but they are said to lack specificity. In the context of a range of mucosal abnormalities and the concept of potential CD, they may be the only available immunological marker for the whole range of gluten sensitivity of which CD is only a part. Further support for our contention comes from our HLA studies. Within the group of patients with neurological disease and gluten sensitivity (defined by the presence of anti-gliadin antibodies) we have found a similar HLA association to that seen in patients with CD: 70% of patients have the HLA DQ2 (30% in the general population), 9% have the HLA DQ8, and the remainder have HLA DQ1. The finding of an additional HLA marker (DQ1) seen in the remaining 20% of our patients may represent an important difference between the genetic susceptibility of patients with neurological presentation to those with gastrointestinal presentation within the range of gluten sensitivity.

(source)



So your elevated IgG is not an indication of celiac disease, but consider this fact: a gluten free diet will certainly not cause you any harm.  You might consider adopting a gluten free diet to see if it makes you feel better and if it helps to resolve the original issue with B-12.  It may take 2 to 6 months for the effect to be apparent, but once again, a GF diet will not harm you.

I hope this helps you decide what to do...

Steve