Speeding up coeliac disease diagnosis in the developing countries.
BACKGROUND
Anti-transglutaminase antibodies are highly predictive markers of active coeliac disease. Because limited facilities are available for routine use of anti-transglutaminase antibodies assays in developing countries, a simple, economical immunological test would represent a great step forward in the screening of coeliac disease.


OBJECTIVE
We determined the prevalence of coeliac disease in two different populations living in an urban area and in a sub-urban impoverished area of Recife (Brazil), using two rapid tests based on detection of anti-transglutaminase antibodies in serum and in one drop of whole blood.


METHODS
Whole-blood and serum samples from 1074 individuals were analysed by the two rapid tests; 580 subjects were university students and 494 subjects were coming from sub-urban impoverished areas, characterized by the endemic presence of filariasis. The positive subjects were evaluated by anti-tranglutaminase enzyme linked immunosorbent assay (ELISA) assay, the coeliac disease-related HLA DQ2/8 and intestinal biopsy.


RESULTS
Both rapid assays were positive in 25/1074 subjects, but only 9/25 (4/4 in urban areas, specificity 100%; 5/21 in poor areas, specificity 76%) were confirmed positive by ELISA assay. The nine subjects testing positive for HLA DQ2 and the intestinal biopsy showed the typical coeliac disease lesions (coeliac disease-prevalence: 0.84%, 9/1074); seven coeliacs were asymptomatic and two presented recurrent abdominal pain.


CONCLUSIONS
The rapid assays were accurate in finding new coeliacs at a remarkably low cost. We are convinced that this new way of testing for coeliac disease can be successfully used by non-specialized personnel in daily practice in developing countries.
Crovella
S
S
Department of Reproductive and Developmental Sciences, University of Trieste, Institute of Child Health I.R.C.C.S. Burlo Garofolo, Italy.
Brandao
L
L
Guimaraes
R
R
Filho
J L de Lima
JL
Arraes
L C
LC
Ventura
A
A
Not
T
T
D000328:Adult; D000906:Antibodies / Q000032:analysis*; D001706:Biopsy; D001938:Brazil / Q000453:epidemiology; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D003906:Developing Countries; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D012189:Retrospective Studies; D012424:Rural Population; D011503:Transglutaminases / Q000276:immunology*; D014505:Urban Population
D000906:Antibodies; D011503:Transglutaminases