title: Antiendomysium antibodies assay in the culture medium of intestinal mucosa:  an accurate method for celiac disease diagnosis.
abstract: BACKGROUND
  Celiac disease (CD) diagnosis is becoming more difficult as patients with no intestinal histology lesions may also be suffering from CD.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of antiendomysium (EmA) assay in the culture medium of intestinal biopsies for CD diagnosis.
  
  
  METHODS
  The clinical charts of 418 patients with CD and 705 non-CD controls who had all undergone EmA assay in the culture medium were reviewed.
  
  
  RESULTS
  EmA assay in the culture medium had a higher sensitivity (98 vs. 80%) and specificity (99 vs. 95%) than serum EmA/antibodies to tissue transglutaminase (anti-tTG) assay. All patients with CD who were tested as false-negatives for serum EmA and/or anti-tTG (32 adults and 39 children) carried the human leukocyte antigen alleles associated to CD. Furthermore, during the follow-up, four patients with negative-serum EmA/anti-tTG, normal villi architecture, and positive-EmAs in the culture medium, developed villous atrophy and underwent gluten-free diet with consequent resolution of the symptoms and complete intestinal histology recovery.
  
  
  CONCLUSIONS
  EmA assay in the culture medium should be included in the diagnostic criteria for CD diagnosis in 'seronegative' patients.
authors: Department of Internal Medicine, Ospedali Civili Riuniti, Sciacca AG, Italy. acarroccio@hotmail.c
authors: Antonio
authors: A
authors: Carroccio
authors: Giuseppe
authors: G
authors: Iacono
authors: Lidia
authors: L
authors: Di Prima
authors: Giuseppe
authors: G
authors: Pirrone
authors: Francesca
authors: F
authors: Cavataio
authors: Giuseppe
authors: G
authors: Ambrosiano
authors: Carmelo
authors: C
authors: Sciumè
authors: Girolamo
authors: G
authors: Geraci
authors: Ada
authors: A
authors: Florena
authors: Saverio
authors: S
authors: Teresi
authors: Franco
authors: F
authors: Barbaria
authors: Ilenia
authors: I
authors: Pepe
authors: Giuseppina
authors: G
authors: Campisi
authors: Pasquale
authors: P
authors: Mansueto
authors: Maurizio
authors: M
authors: Soresi
authors: Gaetana
authors: G
authors: Di Fede
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000032:analysis* / Q000097:blood; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D004386:Duodenum / Q000276:immunology / Q000473:pathology; D004812:Epidemiologic Methods; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000276:immunology; D046509:Tissue Culture Techniques; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D003470:Culture Media; D011503:Transglutaminases