title: Determining IgA and IgG antigliadin, IgA antitransglutaminase, and antiendomysial antibodies in monkey esophagus and in umbilical cord for diagnosis of celiac disease in developing countries.
abstract: OBJECTIVE
  To assess the efficiency of determining IgA and IgG antigliadin antibodies (IgA- and IgG-AGA, respectively), antitransglutaminase (TgA), and anti-endomysial antibodies (AEA) in human umbilical cord (CO) and monkey esophagus for diagnosis of celiac disease; to determine the correlation between serological markers and celiac disease.
  
  
  METHODS
  A total of 400 patients were divided in 3 groups: group 1 with 37 patients with celiac disease, group 2 with 208 patients with no enteropathies, and group 3 with 155 patients with other enteropathies. IgA-AGA, IgG-AGA, and TgA were assessed using enzyme-linked immunosorbent assay, whereas AEA was evaluated by indirect immunofluorescence.
  
  
  RESULTS
  Sensitivity and specificity of IgA-AGA were 81.1% and 95.2%, of IgG-AGA 89.2% and 95.2%, of TgA 83.9% and 96.8%, of AEA-CO 87.9% and 100%, and of AEA of monkey esophagus 88.6% and 100%, respectively. Positive predictive values were 75.0%, 76.7%, 83.9%, and 100%. Negative predictive values were 96.6%, 98.0%, 96.8%, and 97.7% for IgA-AGA, IgG-AGA, TgA, and AEA, respectively. Multivariate analysis showed a strong association between AEA-CO and celiac disease and a good correlation with other markers (TgA, IgA-AGA, and IgG-AGA).
  
  
  CONCLUSIONS
  TgA has been recommended for screening patients with celiac disease. Considering the similar sensitivity and specificity of IgA-AGA and TgA and their correlations in the multivariate analysis, both are applicable for this purpose. However, because TgA tests are highly costly and celiac disease is associated with IgA deficiency, the determination of IgA-AGA and IgG-AGA, followed by AEA-CO, is suitable for screening in developing countries, provided a cutoff point for these examinations is established. The results of antiendomysial antibodies in umbilical cord overlapped those in monkey esophagus. Therefore, umbilical cord should be used as a substrate instead of specimens from endangered species.
authors.affiliation: Departments of Complementary Medicine, FM/UFMG, Avenida Alfredo Balena 190, s/6000, 30130-100, Belo Horizonte, Minas Gerais, Brazil. magbahia@medicina.ufmg.br
authors.forename: Magda
authors.initials: M
authors.lastname: Bahia
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Penna
authors.forename: Ivan Barbosa Machado
authors.initials: IB
authors.lastname: Sampaio
authors.forename: Geraldo Magela Fritz
authors.initials: GM
authors.lastname: Silva
authors.forename: Eugênio Marcos Goulart
authors.initials: EM
authors.lastname: Andrade
mesh_terms: D000818:Animals; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004947:Esophagus / Q000276:immunology / Q000473:pathology; D005260:Female; D005455:Fluorescent Antibody Technique / Q000379:methods; D005903:Gliadin / Q000276:immunology*; D000882:Haplorhini; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D007583:Jejunum / Q000276:immunology / Q000473:pathology; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*; D014470:Umbilical Cord / Q000276:immunology / Q000473:pathology
chemical_list: D000888:Antibodies, Anti-Idiotypic; D001323:Autoantibodies; D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin; D011503:Transglutaminases