Celiac disease: are endomysial antibody test results being used appropriately?
BACKGROUND
The aim of this study was to retrospectively examine how positive IgA-endomysial antibody (EMA) test results for celiac disease were being interpreted and acted on by physicians in the Calgary Health Region.


METHODS
We reviewed consecutive EMA test results, with or without a serum IgA, obtained during a 17-month period. Seropositive tests were cross-referenced to the surgical database to determine the number of patients who underwent intestinal biopsy and the results of the biopsy. We sent questionnaires to the ordering physicians of positive tests with no record of intestinal biopsy.


RESULTS
Among 11,716 EMA tests in 9533 patients, 349 results were positive in 313 patients (3%). Intestinal biopsies were performed in 218 (70%) of the seropositive patients; 194 of them were diagnostic of celiac disease. Celiac disease was also found in 10 EMA-negative patients. Of the 109 positive tests performed in 95 patients with no subsequent biopsy, 28 had appropriate indications to not perform a biopsy; the most common reason being that the test had been ordered to follow up on a previous biopsy-proven diagnosis of celiac disease (n = 21). For 33 other positive test results without a subsequent biopsy, management appeared to be inappropriate, most commonly (n = 21) because of a recommendation to follow a gluten-free diet despite lack of a tissue diagnosis of celiac disease. For the remaining 48 positive EMA results, administrative issues prevented evaluation (n = 19), the patients refused further evaluation (n = 11), or physician surveys were not returned (n = 18).


CONCLUSIONS
Celiac disease affected 2% of patients, with a similar prevalence in male and female patients. Most positive EMA tests (77%) were appropriately managed by physicians. Beginning a gluten-free diet without biopsy or failing to follow up on a positive EMA test remain common errors of management.
McGowan
Kelly E
KE
Department of Pediatrics, Calgary Laboratory Services, University of Calgary, Calgary, Alberta, Canada.
Lyon
Martha E
ME
Loken
Steven D
SD
Butzner
J Decker
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D003238:Connective Tissue / Q000276:immunology; D016208:Databases, Factual; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007422:Intestines / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010820:Physicians; D012189:Retrospective Studies; D012698:Serologic Tests; D011795:Surveys and Questionnaires
D001323:Autoantibodies; D007070:Immunoglobulin A