title: Detection of secretory IgA antibodies against gliadin and human tissue transglutaminase in stool to screen for coeliac disease in children: validation study.
abstract: OBJECTIVE
  To evaluate two commercial stool tests for detection of secretory IgA antibodies against gliadin and human tissue transglutaminase for diagnosis of coeliac disease in children with symptoms.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  Coded stool samples from 20 children with newly diagnosed coeliac disease and 64 controls. Six children with coeliac disease had stool tests every two weeks for three months after starting a gluten-free diet.
  
  
  METHODS
  Secretory IgA antibodies against gliadin and human tissue transglutaminase in stool samples, determined in duplicate by using recommended cut-off limits.
  
  
  RESULTS
  Sensitivity of faecal antibodies against human tissue transglutaminase was 10% (95% confidence interval 1% to 32%), and specificity was 98% (91% to 100%). For antibodies against gliadin, sensitivity was 6% (0% to 29%) and specificity was 97% (89% to 100%). Optimisation of cut-off limits by receiver operating characteristic analysis and use of results of both tests increased sensitivity to 82%, but specificity decreased to 58%. All follow-up stool tests remained negative, except for two positive anti-gliadin results in one patient, six and 10 weeks after the gluten-free diet was started.
  
  
  CONCLUSIONS
  Neither stool test was suitable for screening for coeliac disease in children with symptoms.
authors.affiliation: Division of Gastroenterology, Dr. v. Haunersches Kinderspital, Ludwig Maximilians University, 80337 Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kappler
authors.forename: Susanne
authors.initials: S
authors.lastname: Krauss-Etschmann
authors.forename: Veronika
authors.initials: V
authors.lastname: Diehl
authors.forename: Hannelore
authors.initials: H
authors.lastname: Zeilhofer
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000737:chemistry*; D019204:GTP-Binding Proteins / Q000276:immunology*; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007118:Immunoassay / Q000379:methods / Q000592:standards; D007071:Immunoglobulin A, Secretory / Q000032:analysis*; D007223:Infant; D011237:Predictive Value of Tests; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D015415:Biomarkers; D007071:Immunoglobulin A, Secretory; D005903:Gliadin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins