title: Determination of IgG and IgA antibodies against native gliadin is not helpful for the diagnosis of coeliac disease in children up to 2 years old.
abstract: OBJECTIVE
  Assays for antibodies against native gliadin (anti-nGli) are still often assumed to perform better in the diagnosis of coeliac disease in young children than tests for antibodies to deamidated gliadin (anti-dGli), tissue transglutaminase (anti-tTG), and endomysium (EmA). We compared the performance of assays for anti-nGli, anti-dGli, anti-tTG, and EmA in this age group.
  
  
  METHODS
  We investigated retrospectively 184 children (42 with coeliac disease under normal diet and 142 controls) up to 2 years of age. Immunoglobulin (Ig) A- and IgG-anti-dGli, IgA- and IgG-anti-nGli, IgA- and IgG-anti-tTG, and IgA-EmA were measured in serum. Areas under receiver operating characteristics curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, as well as diagnostic odds ratios were calculated.
  
  
  RESULTS
  From all of the tests investigated, only assays for IgG-anti-dGli, IgA-anti-tTG, and IgA-EmA had high specificity (≥ 0.96) connected with high sensitivity (≥ 0.86), with high positive predictive values (≥ 0.52 and ≥ 0.69 at pretest probabilities of 0.05 and 0.1, respectively) and negative predictive values (≥ 0.99 and ≥ 0.98 at pretest probabilities of 0.05 and 0.1, respectively). These assays also showed high positive likelihood ratio (≥ 24) at low negative likelihood ratio (≤ 0.15) and high diagnostic odds ratios (≥ 136).
  
  
  CONCLUSIONS
  Our results do not support the use of assays of anti-nGli to diagnose coeliac disease in young children. IgA-anti-tTG, IgA-EmA, and IgG-anti-dGli perform better than anti-nGli.
authors.affiliation: Children's Hospital of the Clinical Centre, Sankt Georg, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Richter
authors.forename: Xavier
authors.initials: X
authors.lastname: Bossuyt
authors.forename: Pieter
authors.initials: P
authors.lastname: Vermeersch
authors.forename: Holm H
authors.initials: HH
authors.lastname: Uhlig
authors.forename: Martin
authors.initials: M
authors.lastname: Stern
authors.forename: Almuthe
authors.initials: A
authors.lastname: Hauer
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Zimmer
authors.forename: Luisa
authors.initials: L
authors.lastname: Mearin
authors.forename: Johanna Hendrika Clementina
authors.initials: JH
authors.lastname: de Roo
authors.forename: Cornelia
authors.initials: C
authors.lastname: Dähnrich
authors.forename: Thomas
authors.initials: T
authors.lastname: Mothes
mesh_terms: D019540:Area Under Curve; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology; D016009:Chi-Square Distribution; D002675:Child, Preschool; D005260:Female; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D007223:Infant; D016013:Likelihood Functions; D008297:Male; D009132:Muscles / Q000276:immunology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D011503:Transglutaminases / Q000276:immunology
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin; D011503:Transglutaminases