IgA endomysium antibodies--an early predictor for celiac disease in children without villous atrophy.
OBJECTIVE
To evaluate possible differences between children with anti-endomysium antibodies (EMA) positivity and normal small bowel mucosa and children with positive EMA and an enteropathy diagnosed as celiac disease (CD).


METHODS
Children with suspected CD and positive EMA (>or=1/10) undergoing small bowel biopsy during 1996 to 2002, were investigated (n=133). Data registered were: year and month of birth, timing of the first biopsy, sex, heredity for CD, dermatitis herpetiformis and diabetes mellitus and outcome of the anti-gliadin antibody test (AGA). The case group, with EMA positivity and normal histology (n=39; 59% female, mean age at the first biopsy 7.3 years, range 1.4-16), was compared with the disease control group, with positive EMA and a biopsy suggestive and further on diagnosed as CD (n=94; 56% female; mean age 7.6 years at the first biopsy, range 0.70-17).


RESULTS
AGA positivity and heredity for CD were found to predict the outcome of a pathological jejunal mucosa. Nineteen of the 39 children in the case group were rebiopsied of whom 11 had developed an enteropathy during a follow-up period of 2-7 years (median 4.5 years).


CONCLUSIONS
EMA positivity in the absence of small bowel enteropathy could be a very early predictor for later overt CD, and necessitates further follow-up, especially if the child is AGA positive and there is a family history of CD.
Grodzinsky
E
E
Unit of Research and Development in Local Health Care, County of Ostergötland, Linköping, Sweden. Ewa.Grodzinsky@lio.se
Fälth-Magnusson
K
K
Högberg
L
L
Jansson
G
G
Laurin
P
P
Stenhammar
L
L
D000293:Adolescent; D001323:Autoantibodies / Q000097:blood*; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007223:Infant; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D018485:Muscle Fibers, Skeletal / Q000276:immunology*
D001323:Autoantibodies; D007070:Immunoglobulin A; D005903:Gliadin