title: Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy.
abstract: Our aim was to assess differences in the sensitivities of serologic tests used for the diagnosis of celiac disease among patients with varying degrees of villous atrophy. Among 115 adults with biopsy-proven celiac disease who fulfilled strict criteria, including serologic testing at the time of diagnosis and response to a gluten-free diet, 71% had total villous atrophy and 29% partial villous atrophy. Endomysial antibody was positive in 77% of those with total villous atrophy, compared to 33% with partial villous atrophy (P < 0.001). There was no difference in sensitivity when the type of presentation (classical vs. silent) was compared. Endomysial antibody-positive and negative patients did not differ with respect to age at diagnosis, duration of symptoms, mode of presentation, or family history of celiac disease. All anti-tissue transglutaminase-positive patients had TVA on biopsy. Seronegative celiac disease occurs. Endomysial antibody positivity correlates with more severe villous atrophy and not mode of presentation of celiac disease. Serologic tests, in clinical practice, lack the sensitivity reported in the literature.
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Abrams
authors.forename: Beverly
authors.initials: B
authors.lastname: Diamond
authors.forename: Heidrun
authors.initials: H
authors.lastname: Rotterdam
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D000328:Adult; D001284:Atrophy / Q000453:epidemiology / Q000473:pathology; D001323:Autoantibodies / Q000276:immunology*; D001707:Biopsy, Needle; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011336:Probability; D012680:Sensitivity and Specificity; D012698:Serologic Tests; D012720:Severity of Illness Index
chemical_list: D001323:Autoantibodies; D005903:Gliadin