My daughter just had three screening tests for celiac disease.The gliadin antibody was high (29), but the IGa and transglutamine IGa were negative, and the doctor. says this means she doesn’t have celiac disease because all three need to be positive for a diagnosis. What do these tests mean? Is it likely that my daughter will develop celiac disease?

For a number of years now, it has been realised that type 1A (autoimmune) diabetes may occur with a variety of other autoimmune conditions. By far the most common of these is hypothyroidism, but the incidence of celiac disease in what is now known as the Autoimmune Polyglandular Syndrome Type II is about 8% and is also now usually screened for as a routine. Nowadays, antigliadin tests are considered too non specific to be relied on for diagnosis, and the negative anti transglutaminase test alone would be sufficient to discount celiac disease.

The components of this syndrome however do not all develop at the same time so that it is possible that your daughter might develop this syndrome in the future, although there are as yet no reliable figures on which to estimate this possibility. However, only if there were gastrointestinal symptoms, a fall off in growth or unexplained difficulties with control, it would it be appropriate to repeat the anti-glutamyltransferase test and to consider an intestinal biopsy. There is a recent review which may interest you. See Lepers S, Soula F, Fily S, Fontaine E, Vuye S, Colombel JF, Guimber D, Prin L, Dubucquoi S. Relevance of anti-tissue transglutaminase antibodies in coeliac disease diagnosis Ann Biol Clin (Paris). 2003 May-Jun;61(3):337-43.

DOB