Low prevalence of antigliadin and anti-endomysium antibodies in subclinical/silent celiac disease.
OBJECTIVE
Endomysial antibodies (EMA) are a well-known hallmark of celiac disease, but some recent studies showed that the prevalence of these antibodies in clinical practice is lower than expected. The aim of our study was to determine the prevalence of antigliadin (AGA) and EMA antibodies on a consecutive series of subclinical/silent celiac patients.


METHODS
We studied 115 consecutive patients with subclinical (92 patients) or silent (23 patients) forms of celiac disease. AGA and EMA were screened in all patients. Histopathology of celiac disease was expressed according to the Marsh classification.


RESULTS
The overall AGA in subclinical form were positive in 77% (14 of 18) of patients with partial villous atrophy (VA), in 84% (21 of 25) of patients with subtotal VA, and in 90% (27 of 30) of patients with total VA, whereas EMA were positive in 88.88% (16 of 18) of patients with partial VA, in 92% (23 of 25) of patients with subtotal VA, and 96.66% (29 of 30) of patients with total VA. On the other hand, AGA were positive in 0% (zero of two) of patients with Marsh I and in 30% (three of 10) of patients with Marsh II, whereas EMA were positive in 0% (zero of two) of patients with Marsh I and in 40% (four of 10) of patients with Marsh II (Marsh I-IIIa vs Marsh IIIb-c, p = < 0.005 in overall AGA-positive patients and p = < 0.0001 in EMA-positive patients). At the same time the overall AGA in silent form were positive in 60% (three of five) of patients with partial VA, in 66.66% (four of six) of patients with subtotal VA, and in 77.77% (seven of nine) of patients with total VA, whereas EMA were positive in 80% (four of five) of patients with partial VA, in 83.33% (five of six) of patients with subtotal VA, and in 88.88% (eight of nine) of patients with total VA. On the other hand, overall AGA were positive in 0% of patients with both Marsh I (zero of one) and Marsh II (zero of two), as well as EMA were positive in 0% with both Marsh I (zero of one) and Marsh II (zero of two) (Marsh I-IIIa vs Marsh IIIb-c, p = < 0.001 in overall AGA-positive patients and p = < 0.007 in EMA-positive patients).


CONCLUSIONS
At this time small bowel biopsy seems to be the only correct procedure to diagnose a case of suspected celiac disease, especially in patients with mild symptoms or suspected for celiac disease, because they belong to high-risk groups.
Tursi
A
A
Division of Internal Medicine, Umberto I Hospital, Barletta, Italy.
Brandimarte
G
G
Giorgetti
G
G
Gigliobianco
A
A
Lombardi
D
D
Gasbarrini
G
G
D000293:Adolescent; D000328:Adult; D000906:Antibodies / Q000032:analysis*; D001284:Atrophy; D002446:Celiac Disease / Q000276:immunology* / Q000473:pathology; D004384:Duodenoscopy; D004945:Esophagoscopy; D005773:Gastroscopy; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007422:Intestines / Q000473:pathology; D008871:Microvilli / Q000473:pathology; D009132:Muscles / Q000276:immunology*
D000906:Antibodies; D005903:Gliadin