coeliac markers

[kimnz]

Hi there,

Could someone please tell me what "coeliac markers" I should be asking for when I see our Dr (blood test).

I believe that coeliac disease doesn't always show up with normal blood tests but that there are extra ones that do show it up. I have no idea what the other tests are (apart from bowel biopsy).

Do you?

KimNZ

[wrblack]

Hi, Kim,
We all wish things had gone more smoothy for Jordan. Hope you get more help and have some improvement soon.
Meanwhile, wanted to let you know that next door to Dr. Leshin's essay on constipation, with its references to Hirschsprung's, he has an essay on Celiac disease, www.ds-health.com/celiac.htm
which says, in part,
<<The main way of diagnosing CD has always been through biopsy of the small bowel. Under a microscope, the small bowel will show characteristic damage to the lining. One way this is done by having the patient swallow a capsule attached to a string, which is used to retrieve the capsule after a period of time. Many doctors prefer to do a biopsy under direct endoscopy, however, especially in children. The lining of the small bowel has certain characteristics under a microscope when CD is present.

Since a small bowel biopsy is neither easy nor cheap, it's not in the best interest of the child or family to do a biopsy on every child with DS. So the best thing would be to have an easy blood test that can detect the children who need the diagnostic biopsy. A few blood tests have been tried in the past with unhelpful results, such as the antigliadin antibody (AGA) test, which is pretty much abandoned now. The next blood test developed looks for antiendomysium (or antiendomysial) antibodies (EMA). While the EMA test is superior to the antigliadin test, the interpretation of the test is operator-dependent and prone to errors. The newest blood test looks for IgA antibodies to the enzyme transglutaminase (TG). TG is an intracellular enzyme that binds gliadin and starts to process it in a way that starts the autoimmune sequence in CD. As the TG test has turned out to be a very sensitive and specific screening test for CD, it has become the favored screening test, especially for children and adults who have no symptoms of CD. Note that all these tests are measuring IgA levels of the antibodies. One problem is that IgA deficiency may occur in people with CD, and therefore the IgA markers for CD may not show up. That would classify as a "false negative." For that reason, every time a person has blood tests for CD, the doctor should also test for total IgA levels.

Recent research has found that 97 to 98% of all cases of CD are found in people with certain genetic markers. These genetic markers are called HLA ("human leukocyte antigen") markers. There are two markers that are associated with CD: HLA-DQ2 and HLA-DQ8. In cases where CD is suspected and there is an IgA deficiency, these markers can be looked for instead to determine if a small bowel biopsy is warranted. Children with DS and CD also have the same markers. Interestingly, the genes for the HLA markers are on the chromosome 6, so the connection to chromosome 21 still needs to be discovered.

It's important to note that infection from Giardia, a microscopic parasite found worldwide, can mimic CD. Diagnosis of this infection is done by special tests on the stools.

Treatment is both simple and difficult: a gluten-free diet ...>>
Dr. Leshin has links to other resources and an algorithm on screening tests.
HTH, Bob

[kimnz]

Thank you Bob!!

That's just what I was looking for and I will copy it off and give to the paediatrician. Our paeds in this area are general ones so anything specific is wonderful. In Auckland (our largest city) and other areas of NZ they would have paeds that are more specialised but not where I live in the North.

Kim nz

[Ashlea]

Kim do you thinkn your child has Celiac? Chandler (age 6) was diagnosed about 3 years ago. The blood test was what raised concerns but the upper GI biopsy confirmed that he did in fact have Celiac. The blood test alone is not enough for a Celiac Diagnosis.

[kimnz]

When we were down in Auckland (for Jordan's Hirschsprung's operation) we were suppossed to have got coeliac markers (we spell it differently over here) done. Jordan's bms are still offensive smelling since the operation. However they weren't done so when we went to visit the paediatrician here in our area (Northland Whangarei).

I printed out the information that Bob gave me in the above letter. She took a brief look at it and said we always do "IgA" and that was the end of it. The print out said "total" IgA which I imagine is different for IgA. Is it??

As we have to go back for further bowel surgery I thought that if there was any discrepancy with the cd blood test........they they could do a biopsy while he was under the GA.

I have been given a blood test form for CD markers only and I am presuming that this may not show up CD...if he did happen to have it.

I thought they did a bowel biopsy......do they do a stomach biopsy?

I also thought that if there were starving Jordan for GA that the antibodies wouldn't show high as he would have been without food for 4 days prior to the bowel surgery (Hisrschsprungs).

Kim

[Ashlea]

The biopsy is an upper GI. They look at the section where the stomach connects to the small intestines. The Upper GI test would probably be okay even if he was without food for 4 days because the damage to the small intestines which is what they are looking for would still be there. I would make sure and ask for the test results fromthe IgA test though. There should be 3 different numbers.