A case for discussion: what is the next step?

30. November 2022.

Six years old boy, presented to our Clinic with recurrent abdominal pain
for more than 6 months. He has had normal weight gain and physical status.
He hasn`t had any allergies.
Standard laboratory tests performed earlier was completely normal
(including CBC, iron, liver transaminases, amylase, lipase, and creatinine
level).
Coeliac disease screening : anti-tTG-IgA < 0,1 U/ml (negative), IgG-DGP
slightly increased 10 U/ml (negative <8 U/ml) and decreased total IgA <
0,05 g/l (lower than normal for age).
Question: what will you suggest as the next step

repeat serology once more after some period of time
do the biopsy
test for genetic disposition

Expert answer #1

This child is IgA deficient, so the choice of IgG DGP or other IgG Abs is appropriate. However in the setting of very low IgG DGP, one could discuss with parents the option of continous gluten ingestion and repeated IgG tests in few months. In case of high titres at that time, biopsy should be made.
HLA could be of some help if negative. Not very much if positive.
If parents are very concerned about the abdominal pain and would like to go on a GFD, perform biopsy earlier, risking unspecific or mild changes.