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Here's what the research I've done has turned up, including my discussions with my GI dr.,.

(1) Antibodies show there is a reaction to something. There are several antibodies they look at in celiac (different dr's do different tests). The antigliadin antibodies show that your body is producing antibodies to gluten--this could show a gluten intollerance. Anti-transglutamase antibodies show an autoimmune reaction in the intestine. I forget what the antiendomesial (sp?) antibodies show... I didn't have that test done.

(2) The biopsy confirms celiac, true, BUT... You can have early stages with high levels of antibodies but no obvious antestinal damage yet. It's at this point that different doctors and patients make different choices. Some people choose to eliminate gluten now (why bother damaging your intestine if you don't have to? is the reasoning), others choose to continue eating gluten until signs of damage are found (why give up yummy gluten if there's no damage yet? is the reasoning here.) If you're in the first group, there's the stigma with some doctors of having "self-diagnosed" celiac. In the second group, you should continue to have some follow up, either when symptoms get worse, or as discussed with your doctor. Just because you don't have damage now, doesn't mean you won't ever.

The comparison I have is that I just found out my thyroid antibodies are elevated. My thyroid function is still within the normal range (just barely though), so I don't know yet if they'll treat it. Because they don't know the "trigger" for thyroid autoimmune problems, there's nothing to do except wait for my thyroid to fail (we don't know yet if it will be hyper or hypo, but it will happen). With celiac, if you have the antibodies, you can either wait for damage to occur (and have an "official" celiac diagnosis) or you can remove the trigger, gluten, since they know what it is. (It's the only autoimmune disorder with a known trigger.) No one can tell you what the best choice is, but you should be aware of the options.

Hope this helps clarify things a little. Let me know if you have more questions.


P.S. I think there was also a question about how eliminating gluten can affect the testing. Everything I have read says not to eliminate gluten in the testing phase. For some people, the antibodies can drop *very* quickly in the absence of gluten (other people take much longer, I have not figured out why there is a difference). Since you don't know which you'll be, you should definitely be consuming gluten when you have the antibody blood tests.

The biopsy is a little different. My antibody levels came back off the charts high, and the GI recommended eliminating or reducing gluten asap, even though the biopsy wasn't scheduled for three weeks. I gradually eliminated it over the course of those weeks, and my biopsy was still positive, but my damage was also pretty severe. The intestine does heal, and if you have minor damage and are GF for a while before the biopsy, this could cause incorrect results. On the other hand, if the damage is pretty bad, it can take up to 1-2 years for the intestine to heal completely.

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