title: Antiendomysial and antihuman recombinant tissue transglutaminase antibodies in the diagnosis of coeliac disease: a biopsy-proven European multicentre study.
abstract: OBJECTIVE
  To investigate the value of serum antitissue transglutaminase IgA antibodies (IgA-TTG) and IgA antiendomysial antibodies (IgA-EMA) in the diagnosis of coeliac disease in cohorts from different geographical areas in Europe. The setting allowed a further comparison between the antibody results and the conventional small-intestinal histology.
  
  
  METHODS
  A total of 144 cases with coeliac disease [median age 19.5 years (range 0.9-81.4)], and 127 disease controls [median age 29.2 years (range 0.5-79.0)], were recruited, on the basis of biopsy, from 13 centres in nine countries. All biopsy specimens were re-evaluated and classified blindly a second time by two investigators. IgA-TTG were determined by ELISA with human recombinant antigen and IgA-EMA by an immunofluorescence test with human umbilical cord as antigen.
  
  
  RESULTS
  The quality of the biopsy specimens was not acceptable in 29 (10.7%) of 271 cases and a reliable judgement could not be made, mainly due to poor orientation of the samples. The primary clinical diagnosis and the second classification of the biopsy specimens were divergent in nine cases, and one patient was initially enrolled in the wrong group. Thus, 126 coeliac patients and 106 controls, verified by biopsy, remained for final analysis. The sensitivity of IgA-TTG was 94% and IgA-EMA 89%, the specificity was 99% and 98%, respectively.
  
  
  CONCLUSIONS
  Serum IgA-TTG measurement is effective and at least as good as IgA-EMA in the identification of coeliac disease. Due to a high percentage of poor histological specimens, the diagnosis of coeliac disease should not depend only on biopsy, but in addition the clinical picture and serology should be considered.
authors.affiliation: Tampere University Hospital and University of Tampere, Finland. pekka.collin@uta.fi
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.forename: Harald
authors.initials: H
authors.lastname: Vogelsang
authors.forename: Ilma
authors.initials: I
authors.lastname: Korponay-Szabó
authors.forename: Rudolf
authors.initials: R
authors.lastname: Sommer
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schreier
authors.forename: Umberto
authors.initials: U
authors.lastname: Volta
authors.forename: Alessandro
authors.initials: A
authors.lastname: Granito
authors.forename: Lorenza
authors.initials: L
authors.lastname: Veronesi
authors.forename: Françoise
authors.initials: F
authors.lastname: Mascart
authors.forename: Annick
authors.initials: A
authors.lastname: Ocmant
authors.forename: Anneli
authors.initials: A
authors.lastname: Ivarsson
authors.forename: Carina
authors.initials: C
authors.lastname: Lagerqvist
authors.forename: Annemarie
authors.initials: A
authors.lastname: Bürgin-Wolff
authors.forename: Faruk
authors.initials: F
authors.lastname: Hadziselimovic
authors.forename: Raoul I
authors.initials: RI
authors.lastname: Furlano
authors.forename: Marc A
authors.initials: MA
authors.lastname: Sidler
authors.forename: Chris J J
authors.initials: CJ
authors.lastname: Mulder
authors.forename: Marije S
authors.initials: MS
authors.lastname: Goerres
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Mearin
authors.forename: Maarten K
authors.initials: MK
authors.lastname: Ninaber
authors.forename: Eivind
authors.initials: E
authors.lastname: Gudmand-Høyer
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Fabiani
authors.forename: Carlo
authors.initials: C
authors.lastname: Catassi
authors.forename: Helena
authors.initials: H
authors.lastname: Tidlund
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Alainentalo
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000473:pathology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007223:Infant; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000276:immunology*; D011994:Recombinant Proteins / Q000276:immunology; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D007070:Immunoglobulin A; D011994:Recombinant Proteins; D011503:Transglutaminases