What does an elevated IgA with low deamidated gliadin antibodies and slightly elevated tTG in a celiac panel indicate?

Interpretation of Celiac Panel Results

Your celiac panel results are essentially negative and do not support a diagnosis of celiac disease. The normal total IgA level (196 mg/dL) confirms the validity of the IgA-based antibody tests, and all celiac-specific antibodies are within normal limits 1.

Understanding Your Results

Total IgA Level

• Your total IgA of 196 mg/dL is normal, which confirms that IgA-based antibody tests are reliable and not falsely negative due to IgA deficiency 1
• IgA deficiency occurs in 1-3% of celiac disease patients and would invalidate IgA-based testing, but this is not your situation 1

Tissue Transglutaminase (tTG) Antibodies

• Your tTG IgA is <2 U/mL and tTG total is 3 U/mL, both well below diagnostic thresholds 1
• The American Gastroenterological Association reports that tTG IgA has 90-96% sensitivity for celiac disease at thresholds of 15 U/mL in adults and 20 U/mL in children 1
• Your levels are far below these diagnostic cutoffs, effectively excluding celiac disease 1

Deamidated Gliadin Peptide (DGP) Antibodies

• Your DGP IgA is 5 U/mL and DGP IgG is 3 U/mL, both within normal ranges 2, 3
• While deamidated gliadin antibodies can have high specificity (up to 100% for IgG-DGP), your levels do not suggest celiac disease 2
• The combination of negative tTG and negative DGP antibodies has excellent negative predictive value 3

Clinical Implications

What This Means

• With normal total IgA and negative celiac-specific antibodies, celiac disease is effectively ruled out 1
• If you are currently consuming gluten regularly, these results are reliable 1
• No further celiac-specific testing or intestinal biopsy is indicated based on these results 1

Important Caveats

• These results are only valid if you have been consuming adequate gluten (at least 10g daily) at the time of testing 1
• If you had already eliminated or significantly reduced gluten intake before testing, results could be falsely negative and testing would need to be repeated after gluten reintroduction for 6-8 weeks 1
• If clinical suspicion remains extremely high despite negative serology (such as in patients with first-degree relatives with celiac disease, type 1 diabetes, or autoimmune thyroid disease), biopsy could still be considered, though this is uncommon 1

Alternative Considerations

• If you have gastrointestinal symptoms, other diagnoses should be explored, as celiac disease is not the cause based on these results 1
• Consider evaluation for irritable bowel syndrome, inflammatory bowel disease, or non-celiac gluten sensitivity if symptoms persist 1