Anti tissue transglutaminase antibodies as predictors of silent coeliac disease in patients with hypertransaminasaemia of unknown origin.
BACKGROUND
Unexplained hypertransaminasaemia can be regarded as an extraintestinal presentation of coeliac disease.


OBJECTIVE
To evaluate the reliability of immunoglobulin A anti tissue transglutaminase antibodies for identifying coeliac disease in those patients with raised transaminases of unknown origin.


METHODS
Of 1,120 consecutive patients referred to the outpatient clinic for liver disease due to raised transaminases from September 1995 to December 1999, 110 were classified as having cryptogenic hypertransaminasaemia after the exclusion of every known cause of liver disease.


METHODS
These 110 patients were tested for immunoglobulin A anti tissue transglutaminase and antiendomysial antibodies by enzyme-linked immunosorbent assay and indirect immunofluorescence, respectively.


RESULTS
Ten patients resulted positive for both antibodies; in all of them duodenal biopsy showed a subtotal villous atrophy consistent with coeliac disease. They did not complain of any gastrointestinal symptom. Liver biopsy, performed in five, showed a histological picture of non-specific reactive hepatitis.


CONCLUSIONS
Due to the high proportion (9.15%) of patients with cryptogenic hypertransaminasaemia affected by symptomless coeliac disease, serological screening for gluten-sensitive enteropathy must be included in the work-up of these patients. In this respect, anti tissue transglutaminase antibodies represent a valid alternative to antiendomysial antibodies with the advantage of being feasible everywhere thanks to the worldwide availability of enzyme-linked immunosorbent assay.
Volta
U
U
Department of Internal Medicine, Cardioangiology, Hepatology, University of Bologna, S. Orsola-Malpighi Hospital, Italy. uvolta@orsola-malpighi.med.unibo.it
Granito
A
A
De Franceschi
L
L
Petrolini
N
N
Bianchi
F B
FB
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000906:Antibodies / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006683:HLA-DQ Antigens / Q000097:blood; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007422:Intestines / Q000098:blood supply / Q000473:pathology; D007558:Italy / Q000453:epidemiology; D008099:Liver / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011503:Transglutaminases / Q000097:blood / Q000276:immunology*; D005723:gamma-Glutamyltransferase / Q000097:blood
D000906:Antibodies; D015415:Biomarkers; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; D006684:HLA-DR Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D011503:Transglutaminases; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase