Esophageal Eosinophilia Associated with False Positive anti-tTG

IgA-Tissue transglutaminase (tTG) is widely used as a screening tool for celiac disease. Multiple causes of false positive results has been reported including IBD, lymphoma or certain infections. Eosinophilic esophagitis has not been reported in association with false positive tTG elevation. A retrospective review of 3 patients seen in the division of Gastroenterology in UBC from 2011-2015. These patients presenting with high tTG (at least 4 up to 10 x ULN), and underwent endoscopy and biopsies to rule out celiac disease. Histology revealed normal duodenal mucosa (normal mucosa, villi and no infiltrative cells including lymphocytes) but only increased eosinophils in the esophagus. In follow up, all patients had significant symptomatic improvement and decreasing tTG while on a gluten-containing diet. Their tTG levels have continued to decrease for those who had it measured, and the symptoms had significantly improved. Conclusion While the number in this series is small, esophageal eosinophilia has not been previously described as a cause for a false positive tTG