title: Diagnostic methods beyond conventional histology in coeliac disease diagnosis.
abstract: BACKGROUND
  Coeliac disease diagnostic criteria currently require the detection of small bowel mucosal villous atrophy and crypt hyperplasia.
  
  
  OBJECTIVE
  To compare conventional histological examination to the determination of small bowel mucosal intraepithelial lymphocytes (IELs) and to serum and intestinal coeliac autoantibodies in untreated coeliac disease with villous atrophy and in mild enteropathy coeliac disease.
  
  
  METHODS
  Study comprised consecutive adult patients with coeliac disease suspicion; villous height-crypt depth ratio (Vh/CrD), the densities of CD3+, gammadelta+ and villous tip IELs and serum and intestinal transglutaminase 2 (TG2)-targeted autoantibodies were studied. Coeliac disease was diagnosed in 223 and excluded in 608 patients. Further, 66 patients were considered to suffer from mild enteropathy coeliac disease. Control group consisted of 138 patients.
  
  
  RESULTS
  Vh/CrD determination detected 77% of untreated coeliac disease patients. Serum coeliac autoantibodies had 84% sensitivity for untreated coeliac disease with villous atrophy and 70% sensitivity for mild enteropathy coeliac disease; the specificity was 100%. Intestinal TG2-targeted autoantibodies had sensitivities of 100% and 93%, and 100% specificity, respectively. gammadelta+ and villous tip IELs proved more reliable than CD3+ IELs.
  
  
  CONCLUSIONS
  Conventional histological examination as the golden standard in coeliac disease diagnosis is questionable. Serum and especially intestinal TG2-targeted autoantibodies seem promising in future coeliac disease diagnostics.
authors.affiliation: Department of Dermatology, Tampere University Hospital, Medical School, University of Tampere, Tampere, Finland. teea.salmi@uta.fi
authors.forename: T T
authors.initials: TT
authors.lastname: Salmi
authors.forename: P
authors.initials: P
authors.lastname: Collin
authors.forename: T
authors.initials: T
authors.lastname: Reunala
authors.forename: M
authors.initials: M
authors.lastname: Mäki
authors.forename: K
authors.initials: K
authors.lastname: Kaukinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D019204:GTP-Binding Proteins; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D008297:Male; D008875:Middle Aged; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012155:Reticulin / Q000276:immunology; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D012155:Reticulin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins