Pathology/celiac or crohns or gluten allergy
QUESTION: Hello Neha Dahiya MD,
Thank you in advance for any help you can give me. I had diarrhea off and on for the past 7 months( no visible blood in stool). I also have eczema rash, I just stopped eating gluten containing foods this past week and the diarrhea has completely stopped. My bowel movements are now normal, and the eczema appears to be slowly going away. In the meanwhile, I have been seeing a Gastroenterologist. He did Colonoscopy, Endoscopy, Small Bowel Series, Blood test and Fecal test. My Endoscopy results are:
Mild active inflammation in laminal propria. Villous pattern preserved.
No crypt hyperplasia or intrapithelial lymphocytosis seen.
Stomach, Antrum, Biopsy:
Mild chronic inactive gastritis. Giemsa/Alcian Blue stains are negative for H. pylori like microorganisms and intestinal metaplasia.
Ileum, Biopsy non-neoplastic small bowel mucosa, negative for inflammation.
Sigmoid, Biopsy non-neoplastic large bowel mucosa, negative for inflammation. Trichrome stain reveals no additional new findings.
Dr. said my colon appeared normal.
Small Bowel Series, every
thing was normal.
Blood test IGA Serum = 268, in range.
Tissue transgluam AB IGA >100 High
Gliadin Deamidated AB, IGA >100 High
IBD differentation Panel = ANCA Screen = negative (ANCA Screen includes P-ANCA< C-ANCA, and Atypical P-ANCA)
Myleoperoxidase AB <1.0= AI, antibody not detected
Proteinase-3 AB <1.0= AI, antibody not detected.
ASCA IGG 109.5 High
ASCA IGA 58.5 High
Fecal test, everything was normal.
My Dr. said the elevated levels in my blood test, although are cause for concern, are not to be used alone in a diagnosis because they have a degree of inaccuracy which is why he performed these additional tests. He said the IBD blood test has a 40/60% accuracy rate, and the Celiac blood test results have a better accuracy rate, but still not definative.
Can you please explain the test findings to me. Thank you so much. Sincerely, Nadia
ANSWER: Hello Nadia:
Your colonoscopies biopsy results show normal intestine, with no inflammation or swelling of lining of intestine.
The endoscopic biopsy for small intestine is also essentially normal with minimal mild swelling.
The stomach biopsy shows mild changes of gastritis ( inflammation)
There aren't findings suggesting celiac disease.
The blood tests - tissue transglutaminase and Gliadin deamidated are elevated suggesting likelihood of celiac disease. However, as your doctor said thy alone are not sufficient to diagnose celiac disease.
It is likely the disease is in very early stage and biopsy done after 6-12 months may show evidence for celiac disease.
All other blood tests are negative.
You may have mild gluten intolerance but have not developed full blown celiac disease
[an error occurred while processing this directive]---------- FOLLOW-UP ----------
QUESTION: Hello Neha Dahiya MD,
Thank you for your answer. I just received additional test results. As far as the clinical diagnosis, my doctor wrote 1) Celiac Disease 2) R/O Crohns Disease. He took 2 biopsys of my sigmoid, one of my ileum, one of my stomach, and two of my duodenum.
Along with the previous test results below are the additional findings.
Esophagus findings: small hiatus hernia, esophageal mucosa.
Antrum: mild erythema
Duodenum: shallow fissures, mosaic pattern.
TTG IgA >100 , Gliadin deaninated >100
ASCA IgA =58 ,IgG =109. These are the findings that concern me the most. My blood test is positive for Crohns?. How accurate is the ASCA IgA/IgG blood test?? Do any of these new biopsy findings point to Crohns whether now or in the future?? Thank you once again for being kind enough to answer my question. Also, are there any statistics regarding Crohns disease blood tests, perhaps a website?
The AnCa is negative in Ulcerative colitis and ASCA is positive in 60-75% cases of Crohn's disease. So your serology is suspicious for Crohns's disease.
The biopsy findings may help to decide in favor of Crohn's. however you do not currently have all he cahracteristic features of Crohn's in the various biopsies
Small and large intestine do not have inflammation, fissures, collection of lymphoid cells (granulomas) . There is no thickening of wall. Duodenum has small fissures, but nothing conclusive.
These diseases, IBD (ulcerative coltis or Crohn's disease) and celiac take time to evolve and show complete picture.
You can check out this website for more information http://www.ccfa.org/what-are-crohns-and-colitis/what-is-crohns-disease/
All the best