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Have Hypothyroid, Osteoporosis, Low Iga And Low Igg1, Elevated ALT. Chances Of Coeliac Disease?

Posted on Thu, 23 May 2013

Question: I am a 61 year old female with a rising MCV,105. My alt is 40 and my ast 33. My rbc's are slightly decreased. I have hypothyroid, osteoporosis, low iga and low igg1. My B12 has tested within normal range. I have had a gi workup for chronic diarrhea one year ago and it was determined to be microbial overload, due to a reaction to truivia, I had a bx which was indicative of celiac but I do not carry the markers (DNA) for celiac, video capsule study was negative for celiac. Abdominal MRI was negative for anything. I have had no alcohol in recent weeks and am not a consistent drinker. Albumin, GGT,LDH etc are all normal. I exercise regularly and occasionally run.

Answered by Dr. Luchuo Engelbert Bain (2 hours later)

Hi and thanks for the query,

I am impressed you exercise regularly and suggest you actually keep on. Your liver function tests are actually within normal limits. It s of utmost importance for you to revisit your gastroenterologist for a formal confirmation coeliac disease. Hope you did a stool test for occult blood and colonoscopy in the diagnostic evaluation of the chronic diarrhea you were experiencing.

The mild anemia needs to be characterized. But from the raised MCV values, its for sure a macrocytic anemia. Normal values of Vitamin B serum levels deserve a blood film to be done again and a hematologist s opinion if it failures to correct after treatment. Chronic gastrointestinal tract bleeding, gastritis and a colonic tumours should also be excluded formerly.

I suggest a reevaluation by a gastroenterologist. I will be very glad addressing specific concerns if you do have any.

Do not hesitate asking further questions. My pleasure.
Best regards,
Dr Luchuo, MD.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Luchuo Engelbert Bain (9 hours later)

I had a complete gi workup including colonoscopy, video capsule study,etc., all test ing for bacteria and parasites and blood. I had The celiac testing blood work which was negative but due to my low iga I was sent to an immunologist. Eventually DNA testing ruled out celiac completely. The biopsy was positive for celiac in the sense it had the same form of damage? The assumption was celiac prior to blood work. The final test was a breath test for microbial overload which was positive and I was treated. I still suffer gi issues but they are presumptively caused by the low iga.I assume the positive biopsy was due to the reaction to my food allergy? So the question is the elevated MCV is probably from a low B12, but aren't there additional tests such as and MMA and homocystine that can support the diagnosis of low B12? And can't blood cell type be determined by looking at a peripheral smear? That's it, you've allayed my fears somewhat and I am grateful for your assistance.

Answered by Dr. Luchuo Engelbert Bain (1 hour later)

Hi and thanks for the query,

The peripheral blood smear could be important in actually determine the cytology. I would however suggest you get a second opinion from a hematologist if anemia actually persists despite Vitamin B12 replacement therapy.

Biopsy today still remains very controversial as gold standard in the diagnosis of celiac disease. Other clinical, immunological and past medical history parameters must be considered before making a diagnosis. I think they were considered sufficiently in your case before the possibility of celiac disease was actually sidelined some how.

My suggestion is first consulting hematologist, and based on his findings and management approach, further testing or opinions from your gastroenterologist could be useful in making further investigations if needed.

Thanks and best regards as I wish you the best of health.
Luchuo, MD.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Luchuo Engelbert Bain (11 hours later)

I am consulting a hematologist and await his results...

Answered by Dr. Luchuo Engelbert Bain (2 hours later)

Hi and thanks for your response,
I strongly think that s the best thing to do for now.
Best regards as we hope for the results.
Wishing you the best of health and best regards,
Luchuo, MD.

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Above answer was peer-reviewed by : Dr. Prasad