Anti-endomysial antibody negative celiac disease: does additional serological testing help?
Anti-endomysium antibodies (AEM) fail to identify all untreated celiac disease (CD) patients. This study aims to determine if additional serology, in particular, IgA anti-tissue transglutaminase (tTG) antibodies, increases detection. Fifty-three biopsy-proven untreated CD patients (39 women, 14 men; median age 51 years) and 65 control patients with normal duodenal histology (46 women, 19 men; age range 17-90 years, median 45 years) were prospectively studied. Serum total IgA, IgA anti-tTG, IgA AEM, IgA anti-gliadin (AGA) and IgG AGA antibodies were measured. Thirteen (25%) CD patients were AEM negative. None were IgA deficient. Three AEM-negative CD patients had a raised IgA anti-tTG and IgA AGA. IgG AGA was raised in 10 AEM-negative CD patients, but also in 14/65 (22%) of controls. In conclusion, AEM-negative CD is common and detection is only modestly enhanced by testing for IgA anti-tTG antibodies. Duodenal biopsy is still recommended for the accurate diagnosis of CD.
Department of Medical Sciences, University of Edinburgh, Scotland, UK.
A
A
Dahele
K
K
Kingstone
J
J
Bode
D
D
Anderson
S
S
Ghosh
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood*; D002446:Celiac Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000276:immunology*; D011446:Prospective Studies; D012155:Reticulin / Q000276:immunology*; D012698:Serologic Tests; D011503:Transglutaminases / Q000276:immunology*
D000906:Antibodies; D007070:Immunoglobulin A; D012155:Reticulin; D011503:Transglutaminases