My four year old son, who has type 1 diabetes diagnosed six months ago, complained of stomach pains, so his doctor ran a gliadin antibody test. The results are as follows IGGA – negative, IGA – Negative, IGG – Positive (25 listed as a weak positive). We have been referred to a gastroenterologist, but there is a two month wait. I understand this could mean celiac disease. Could you explain what the positive result means? What is the antigliadin antibody? Could it be something else? I have already looked up several celiac disease websites, but I am confused by my son’s results.

Celiac disease is one of many autoimmune diseases. It is more common in people with type�1 diabetes, someplace in the 3-10% range. We and many others are now routinely screening all kids with diabetes for celiac disease at diagnosis and annually because of this — just as we do thyroid antibody screening. The old test used anti-gliadin antibody, newer tests used endomysial antibody, and the most sensitive and specific and newest test used is transglutaminase antibody. Anti-gliadin can produce some false positive results so this does not automatically mean that your child has celiac disease. The higher the antibody titers, the more likely the positive diagnosis.

There can also be iron deficiency, immunoglobulin A deficiency as well as lactose intolerance. We think that there may be more unexplained hypoglycemia, but this is not yet a certainty.

If celiac disease is not recognized or very subtle, there can be growth slowdown and also pubertal delay. Old literature with very symptomatic celiac disease patients also suggests increased possibility of intestinal cancers with suggestion that avoiding gluten would decrease these risks.

Nobody has any information on the most subtle and mildest celiac cases now being diagnosed very early or with only positive antibodies, but our hope is that this would further decrease all these problems.

You may want to have your son’s primary doctor or the diabetes team do more specific tests while you are waiting to see the gastroenterologist: blood count, ferritin and iron levels, IgA level, transglutaminase antibody, liver functions, calcium/phosphate levels, albumin/total protein levels since this is the baseline information the GI folks will need anyway — and will give you some idea of any other associated problems. Your son’s primary doctor or the diabetes group may also be able to get you an earlier appointment with the GI folks if you tell them there is an extra long wait.

The Celiac Disease Foundation web site has excellent general information as well as future food suggestions.

SB