A patient who is a “potential celiac” has positive serology (including the highly specific anti-Endomysium antibodies), possibly has symptoms, and has a negative biopsy. A potential celiac may or may not be put on a gluten-free diet, though we typically lean toward recommending the diet even in those potential celiacs who have no symptoms. Early… Read more »
(Updated .)Keyword: positive blood
What are the chances of having a high tTG and a negative biopsy—even though I have a child who was biopsy-diagnosed with celiac—and still being negative for the disease?
It’s possible to be truly negative with these facts, especially if the tTG are only mildly elevated. Also check the more specific EMA test. If it’s positive, we would conclude you’re a potential celiac, which means the disease is simply waiting to explode, and we’d suggest a gluten-free diet.
(Updated .)If someone has positive blood test, positive biopsy, but no response to a gluten-free diet would that mean something other than celiac disease?
It could mean there are other conditions concomitantly causing the symptoms, and they should be thoroughly investigated. If none are found, then the possibility of “refractory sprue” (refractory celiac disease) should be examined by a knowledgeable medical professional.
(Updated .)If you have a positive antibody test and an inconclusive biopsy (it only shows inflammation, but no blunting), what’s the next approach?
A patient and doctor must consider the patient’s clinical history, what antibodies were positive and to what extent, and what, exactly, the biopsy showed to determine what’s next.
(Updated .)Could you have positive blood work and a positive biopsy and not have celiac disease?
Positive blood work (meaning tTG or EMA) and a biopsy consistent with celiac disease are rarely due to other causes. However, Crohn’s disease is known to be often associated with low positive tTG and the changes in the duodenal biopsies can indeed be similar.
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