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Gluten challenge prior to endoscopy? |
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Written by Dr Rodney Ford
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Monday, 28 January 2008 |
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Lots of people ask if they need an endoscopy. This is a complex question.
Lori asks: ”My son (13y) has been anaemic for over 5 years. He recently had a blood test showing a very high tTg (transglutaminase). The gliadin blood test was not done. He has been off gluten 3 months and he had another tTG test which is still very high (over 200 units). "He has been scheduled for tissue biopsy, but we have been told to reintroduce gluten to diet for several weeks prior to scope. But we are hesitant to do this, and want more info first. He does not have intestinal discomfort, or other typical symptoms. "Can high tTg levels of antibodies be from something else? Or just reaction to gluten? We would like to keep him off gluten and do another blood test in three months. But maybe it hasn't been enough time yet. Appreciate your opinion on this. Thank you.”
My Reply:
Your son almost certainly has celiac disease. A very high tTG is almost diagnostic. It shows that his gut is being damaged by gluten
It is most likely to be celiac disease. But other disease (liver damage, gastric reflux, eosinophilic oesophagitis, and inflammatory bowel disease) are associated with high tTG.
It can take years for the tTG antibody to do down on a gluten-free diet.
It can take years for the gut damage to come back again on a gluten diet.
It takes about 6-8 weeks for the gut to heal on a gluten free diet.
Your son needs more testing (liver function, inflammatory markers, genetic marker for coeliac, gluten antibodies to tell you if it is a gluten related problem).
Having said all of this, a biopsy prior to going gluten free is always a good idea. At the moment, it is too late to do a biopsy without him having a good gluten challenge. At this stage I would enjoy his good health and not give him any more gluten for a few years. He can always have a gluten challenge when he is older. Cheers, Dr Rodney Ford.
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Last Updated ( Wednesday, 20 February 2008 )
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