Q & A
Return to ->Ask the Doctor->Tests and Their Results | QUESTION: I am newly diagnosed with Celiac (4 mos.). I have 4 children. All but the 3 yr.old. have been tested. I was told one child tested positive, however the "numbers were such a low positive" that I shouldn't concern myself at this time with trying to put her on a gluten-free diet, but use it as a "red flag" to continue testing down the road. This child also suffers many allergies and is diagnosed with asthma. She also has frequent skin rashes, mostly on her legs. Also, one child that I was told tested negative, in my opinion, has several signs of Celiac -- continual mouth ulcers, sore in the corners of her mouth, fatigue, extremely foul smelling feces w/frequent "tummy problems". However, she is slightly overweight, so the typical malabsorption and weight loss do not seem to be present. My pediatrician had very little information on Celiac and was reluctant to run the labwork until I convinced her to discuss it with my Internist. I would appreciate your opinion/recommendation as to whether I should followup/retest my kids or follow the current advice I've been given. Thank you! | DR. FINE: The problem with blood testing for celiac disease as has been published by several authors is that it only becomes fully positive in the way to be most specific (no false positives) when full blown villous atrophic celiac disease is present. The test most often being used to represent the most specific positive result is anti-endomysial IgA antibodies or anti-tissue transglutaminase IgA antibodies. By this time, in addition to a high likelihood of autoimmune disease being present, so too will malabsorption of nutrients, bone loss, growth delay, etc. Positive blood tests for antigliadin antibodies are usually ignored if the antiendomysial or anti-tissue transglutaminase tests are negative. This is the situation you are describing. Yet herein lies the problem. Having antibodies to gliadin means there has been an immune response, and hence there is immunologic gluten sensitivity as it is called. I have done research (manuscript in preparation) on this showing that even a positive antigliadin antibody alone, although rarely indicating classic celiac disease, indicates gluten sensitivity and a higher likelihood of having intestinal nutrient malabsorption and other abnormal small intestine functions.
It boils down to this: Do you want yourself or your children to be diagnosed only when villous atrophy of the intestine has occurred (when celiac disease has occurred in its classic, end stage form) or are you willing to interevene with a gluten-free diet before this happens to prevent damage to the intestine and other organs. I recommend a preventive approach which is also how and why I have developed tests that can detect antigliadin antibodies (detected in stool) before damage to the small intestine has occurred. |
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