Screening for asymptomatic celiac sprue in families.
We evaluated the reliability of IgA and IgG antigliadin antibodies (AGA-A, AGA-G), antireticulin antibody (ARA), endomysial antibodies (EmA), and alpha 1-antitrypsin clearance (alpha 1-AT CL) in the detection of celiac sprue (CS) in 59 first-degree asymptomatic relatives of celiac patients who had duodenal biopsy. Twenty-four relatives who had normal results of screening tests were selected at random for biopsy; 35 relatives with at least one abnormal test result were biopsied. Eleven relatives were noted to have villous atrophy at biopsy; the diagnosis of celiac sprue was confirmed by histological improvement after gluten-free diet in six. AGA-G, alpha 1-AT CL, and EmA had sensitivities of 73%, 73%, and 64%, respectively, with very high levels of specificity. Sensitivity was improved by the combination of two serological markers (AGA-G + alpha 1-AT CL = 91%; AGA-G + EmA = 82%; EmA + ARA = 82%). Furthermore, combination of EmA and ARA has shown the best specificity and positive predictive value. AGA-G, alpha 1-AT CL, and EmA are reliable individual markers for the detection of asymptomatic celiac sprue. However, a combination of two of them, including ARA, was more sensitive than the individual tests.
Vazquez
H
H
Small Bowel Section, Gastroenterology Hospital, Buenos Aires, Argentina.
Sugai
E
E
Pedreira
S
S
Katz
S
S
Litwin
N
N
De Rosa
S
S
Ruiz
J
J
Soifer
G
G
Kogan
Z
Z
Boerr
L
L
D015415:Biomarkers; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005455:Fluorescent Antibody Technique; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008403:Mass Screening; D018485:Muscle Fibers, Skeletal / Q000276:immunology; D011237:Predictive Value of Tests; D012155:Reticulin / Q000276:immunology; D012680:Sensitivity and Specificity; D000515:alpha 1-Antitrypsin / Q000276:immunology
D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D012155:Reticulin; D000515:alpha 1-Antitrypsin; D005903:Gliadin