Endomysial antibodies predict celiac disease irrespective of the titers or clinical presentation.
OBJECTIVE
To investigate the association between serum antibody levels and a subsequent celiac disease diagnosis in a large series of children and adults.


METHODS
Besides subjects with classical gastrointestinal presentation of celiac disease, the study cohort included a substantial number of individuals with extraintestinal symptoms and those found by screening in at-risk groups. Altogether 405 patients underwent clinical, serological and histological evaluations. After collection of data, the antibody values were further graded as low [endomysial (EmA) 1:5-200, transglutaminase 2 antibodies (TG2-ab) 5.0-30.0 U/L] and high (EmA 1: ≥ 500, TG2-ab ≥ 30.0 U/L), and the serological results were compared with the small intestinal mucosal histology and clinical presentation.


RESULTS
In total, 79% of the subjects with low and 94% of those with high serum EmA titers showed small-bowel mucosal villous atrophy. Furthermore, 96% of the 47 EmA positive subjects who had normal mucosal villi and remained on follow-up either subsequently developed mucosal atrophy while on a gluten-containing diet, or responded positively to a gluten-free diet.


CONCLUSIONS
Irrespective of the initial serum titers or clinical presentation, EmA positivity as such is a very strong predictor of a subsequent celiac disease diagnosis.
Pediatric Research Centre, University of Tampere and Tampere University Hospital, Fin-33014, Tampere, Finland.
Kalle
K
Kurppa
Tiia
T
Räsänen
Pekka
P
Collin
Sari
S
Iltanen
Heini
H
Huhtala
Merja
M
Ashorn
Päivi
P
Saavalainen
Katri
K
Haimila
Jukka
J
Partanen
Markku
M
Mäki
Katri
K
Kaukinen
D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D002446:Celiac Disease / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003238:Connective Tissue / Q000276:immunology*; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007223:Infant; D007413:Intestinal Mucosa / Q000276:immunology; D007421:Intestine, Small / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000276:immunology*; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
D001323:Autoantibodies; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins