Association between anti-endomysial antibody and total intestinal villous atrophy in children with coeliac disease.
BACKGROUND
There is growing evidence to suggest that detection of anti-gliadin antibody (AGA) and anti-endomysial antibody (EmA) can serve as sensitive markers of the degree of histological abnormalities in patients with coeliac disease.


OBJECTIVE
To evaluate the association between the presence of AGA and EmA and villous atrophy in intestinal biopsies of children with suspected coeliac disease.


METHODS
Intestinal samples of 46 children with failure to thrive, chronic diarrhoea, malabsorption and short stature with either AGA and/or EmA positivity were evaluated, retrospectively. The diagnosis of coeliac disease was based on ESPGHAN criteria.


METHODS
Patients with total villous atrophy who fulfilled the ESPGHAN criteria for the diagnosis of coeliac disease were diagnosed to have coeliac disease. Nine patients without villous atrophy were taken as negative controls for this study. AGA-IgA was measured both by immunoflourescence (IF) and ELISA and EmA-IgA by IF while patients were on normal diet. Relationship between autoantibody positivity and intestinal total villous atrophy was evaluated.


RESULTS
Overall positivity for AGA IgA was 85% (39/46) by IF+ELISA and EmA positivity was 85% (39/46) by IF within the study group. Histological examination revealed total villous atrophy with lymphocyte infiltration and crypt hyperplasia in 37 (80%) patients. AGA IgA was positive in 14 (38%) and 31 (84%) of these children by ELISA and IF, respectively. EmA positivity was detected in 35/37 (95%) cases with atrophy and 4/9 (44%) without atrophy (p=0.002). Thirty out of 37 (81%) patients with villous atrophy had both AGA IgA (IF) and EmA positivity (p=0.186). All of the sixteen patients that had both positive AGA IgA (ELISA+IF) and EmA had total villous atrophy (p=0.037).


CONCLUSIONS
A significant association between total villous atrophy and EmA positivity has been documented in this study.
Ozgenc
F
F
Department of Paediatrics, Ege University, Faculty of Medicine, Izmir, Turkey. ozgenc@med.ege.edu.tr
Aksu
G
G
Aydogdu
S
S
Akman
S
S
Genel
F
F
Kutukculer
N
N
Alkanat
M B
MB
Vural Yagci
R
R
D000293:Adolescent; D001284:Atrophy / Q000175:diagnosis; D001323:Autoantibodies / Q000097:blood*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007223:Infant; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D009210:Myofibrils / Q000276:immunology*; D012189:Retrospective Studies
D001323:Autoantibodies; D007070:Immunoglobulin A; D005903:Gliadin