title: Isolated positive anti-gliadin immunoglobin-A antibody in children with gastrointestinal symptoms.
abstract: OBJECTIVE
  The use of immunoglobulin G and A anti-gliadin antibodies for celiac disease screening has decreased due to higher specificity and sensitivity of tissue transglutaminase and endomysial antibodies. Greater values of immunoglobulin-A anti-gliadin antibody have been associated with more severe mucosal damage in proven and probable celiac disease patients. The aim of this study was to determine whether anti-gliadin antibody immunoglobulin A has any clinical importance in diagnosing celiac disease in children. Children with a chronic history of vomiting, abdominal pain, diarrhea, or constipation in the outpatient clinic were evaluated for celiac disease.
  
  
  METHODS
  Tissue transglutaminase and anti-gliadin antibody immunoglobulin A in serum were determined by ELISA test and endomysial antibodies immunoglobulin A by indirect immunofluorescence. Most of these children with isolated positive anti-gliadin antibody immunoglobulin A were further evaluated by performing proximal gastrointestinal biopsies.
  
  
  RESULTS
  Sixteen children had isolated positive anti-gliadin antibody immunoglobulin A (negative tissue transglutaminase and endomysial antibodies immunoglobulin A). Eight were male (mean age: 9.7 years). None had immunoglobulin A deficiency. Thirteen underwent an upper endoscopy with multiple small bowel biopsies. Two patients had villous atrophy and slightly increased intraepithelial lymphocytes (Marsh 3a), which could make the diagnosis of celiac disease likely. These two patients had high titers of anti-gliadin antibody immunoglobulin A above 70 Units.
  
  
  CONCLUSIONS
  An isolated positive antigliadin antibody immunoglobulin A result in the absence of positive tissue transglutaminase and endomysial antibodies immunoglobulin A should raise the suspicion of the diagnosis of celiac disease. This could be a non-specific phenomenon that could be found in other gastrointestinal conditions, latent celiac disease, or gluten hypersensitivity. A longitudinal clinical follow-up is recommended in these children to confirm the diagnosis.
authors.affiliation: Johns Hopkins University School of Medicine, Pediatrics, Baltimore, USA. wkarnsa1@jhmi.edu.
authors.forename: Wikrom
authors.initials: W
authors.lastname: Karnsakul
authors.forename: Kathryn
authors.initials: K
authors.lastname: Skitarelic
authors.forename: Stacey
authors.initials: S
authors.lastname: Gillespie
authors.forename: Thaschawee
authors.initials: T
authors.lastname: Arkachaisri
mesh_terms: D000888:Antibodies, Anti-Idiotypic / Q000276:immunology*; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000276:immunology* / Q000378:metabolism; D002648:Child; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007413:Intestinal Mucosa / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D007421:Intestine, Small / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D008297:Male; D012720:Severity of Illness Index
chemical_list: D000888:Antibodies, Anti-Idiotypic; D007070:Immunoglobulin A; D005903:Gliadin