title: Persistently positive gliadin antibodies without transglutaminase antibodies in the elderly: gluten intolerance beyond coeliac disease.
abstract: BACKGROUND
  The specificity of the conventional gliadin antibody test is considered low.
  
  
  OBJECTIVE
  We explored whether gliadin antibody(AGA)-positivity without tissue transglutaminase antibodies (tTGA) is persistent in the elderly population and whether such positivity indicates overt or potential coeliac disease in genetically predisposed individuals.
  
  
  METHODS
  AGA and tissue transglutaminase antibody were measured in 2089 elderly individuals twice with a three-year interval. AGA-positive but tissue transglutaminase antibody-negative subjects with coeliac-type human leucocyte antigen (HLA) were examined and underwent gastroduodenal endoscopy (cases). Small-bowel mucosal villous morphology and densities of CD3+ and γδ+ intraepithelial lymphocytes and the occurrence of tissue transglutaminase-specific IgA deposits were analysed. Randomly selected persistently AGA-negative age- and sex-matched subjects served as controls.
  
  
  RESULTS
  AGA-positivity was persistent in 81% of those initially positive. Amongst the 49 clinically studied and 36 endoscopied cases only one (2.8%) had coeliac disease. Many (54%) showed signs of inflammation in the biopsy, without villous atrophy. Coeliac-type HLA was not over-represented in the persistently AGA-positive compared to the general population. Persistently AGA-positive coeliac-type HLA-positive subjects had more gastrointestinal symptoms than AGA-negative controls.
  
  
  CONCLUSIONS
  AGA-positivity is often persistent. Overt coeliac disease is seldom found behind persistent AGA-positivity, but this characteristic is associated with mucosal inflammation and gastrointestinal symptoms at least in HLA-positive individuals.
authors.affiliation: Department of Neurology, Päijät-Häme Central Hospital in Lahti, Finland.
authors.forename: Anitta
authors.initials: A
authors.lastname: Ruuskanen
authors.forename: Liisa
authors.initials: L
authors.lastname: Luostarinen
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Ilkka
authors.initials: I
authors.lastname: Krekelä
authors.forename: Heikki
authors.initials: H
authors.lastname: Patrikainen
authors.forename: Jyrki
authors.initials: J
authors.lastname: Tillonen
authors.forename: Kaija
authors.initials: K
authors.lastname: Laurila
authors.forename: Katri
authors.initials: K
authors.lastname: Haimila
authors.forename: Jukka
authors.initials: J
authors.lastname: Partanen
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Raisa
authors.initials: R
authors.lastname: Valve
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood*; D001706:Biopsy; D017252:CD3 Complex / Q000032:analysis; D002446:Celiac Disease / Q000276:immunology* / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D005903:Gliadin / Q000276:immunology*; D006683:HLA-DQ Antigens / Q000032:analysis; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007413:Intestinal Mucosa / Q000473:pathology; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D000906:Antibodies; D017252:CD3 Complex; D006683:HLA-DQ Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin; D011503:Transglutaminases