Screening for celiac disease: a prospective study on the value of noninvasive tests.
OBJECTIVE
Celiac disease is frequently diagnosed in patients with nonspecific abdominal symptoms. Therefore, highly sensitive, specific, and simple noninvasive screening tests are needed.


METHODS
This study compared the usefulness of IgG- and IgA-antigliadin antibodies, IgA-endomysial antibodies, and intestinal permeability in diagnosing celiac disease in 102 adult patients with nonspecific abdominal symptoms. In addition, all patients underwent small bowel biopsy as a gold standard for the diagnosis of celiac disease.


RESULTS
Forty-nine patients were ultimately diagnosed as having celiac disease because of flat mucosa. Flatulence and signs and symptoms dating back to childhood were more frequent and abdominal pain less frequent (p < 0.05) in celiac disease but were not helpful for screening. IgA-endomysial antibodies showed a sensitivity and specificity of 100%; an altered intestinal permeability had also a 100% sensitivity, but only 55% specificity. IgG- and IgA-antigliadin antibodies' sensitivity (73% and 82%, respectively) and specificity (74% and 83%, respectively) were much lower. Combining the two antigliadin antibodies did not significantly improve the sensitivity and specificity.


CONCLUSIONS
Our data show the advantage of IgA-endomysial antibodies for screening of celiac disease except in the case of patients with IgA-deficiency or dermatitis herpetiformis. In these patients, the permeability test could improve noninvasive differential diagnosis.
Vogelsang
H
H
Department of Internal Medicine IV (Gastroenterology and Hepatology, University of Vienna, Austria.
Genser
D
D
Wyatt
J
J
Lochs
H
H
Ferenci
P
P
Granditsch
G
G
Penner
E
E
D000328:Adult; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000517:prevention & control*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis*; D007074:Immunoglobulin G / Q000032:analysis*; D007408:Intestinal Absorption; D007421:Intestine, Small / Q000473:pathology; D007792:Lactulose; D008297:Male; D008353:Mannitol; D008403:Mass Screening; D018485:Muscle Fibers, Skeletal / Q000276:immunology*; D011237:Predictive Value of Tests; D012155:Reticulin / Q000276:immunology; D012680:Sensitivity and Specificity
D007070:Immunoglobulin A; D007074:Immunoglobulin G; D012155:Reticulin; D008353:Mannitol; D007792:Lactulose; D005903:Gliadin