Celiac Disease Tests; Antibody Screening; References

Celiac disease is frequently diagnosed in patients with nonspecific abdominal symptoms. Highly sensitive, specific, and simple noninvasive screening tests are needed. New tests include IgG- and IgA-antigliadin antibodies, IgA-endomysial antibodies, and intestinal permeability in diagnosing celiac disease.

Non-Invasive and Screening Tests

Screening for celiac disease: a prospective study on the value of noninvasive tests.

Author
Vogelsang H; Genser D; Wyatt J; Lochs H; Ferenci P; Granditsch G; Penner E
Address
Department of Internal Medicine IV (Gastroenterology and Hepatology, University of Vienna, Austria.
Source
Am J Gastroenterol, 1995 Mar, 90:3, 394-8

Abstract
OBJECTIVE: Celiac disease is frequently diagnosed in patients with nonspecific abdominal symptoms. Therefore, highly sensitive, specific, and simple noninvasive screening tests are needed. METHODS: This study compared the usefulness of IgG- and IgA-antigliadin antibodies, IgA-endomysial antibodies, and intestinal permeability in diagnosing celiac disease in 102 adult patients with nonspecific abdominal symptoms. In addition, all patients underwent small bowel biopsy as a gold standard for the diagnosis of celiac disease. RESULTS: Forty-nine patients were ultimately diagnosed as having celiac disease because of flat mucosa. Flatulence and signs and symptoms dating back to childhood were more frequent and abdominal pain less frequent (p < 0.05) in celiac disease but were not helpful for screening. IgA-endomysial antibodies showed a sensitivity and specificity of 100%; an altered intestinal permeability had also a 100% sensitivity, but only 55% specificity. IgG- and IgA-antigliadin antibodies' sensitivity (73% and 82%, respectively) and specificity (74% and 83%, respectively) were much lower. Combining the two antigliadin antibodies did not significantly improve the sensitivity and specificity. CONCLUSIONS: Our data show the advantage of IgA-endomysial antibodies for screening of celiac disease except in the case of patients with IgA-deficiency or dermatitis herpetiformis. In these patients, the permeability test could improve noninvasive differential diagnosis.

IgA antigliadin antibodies as a screening method for nonovert celiac disease in children with insulin-dependent diabetes mellitus.

Author
Calero P; Ribes-Koninckx C; Albiach V; Carles C; Ferrer J
Address
Endocrinology and Gastroenterology Units, La Fe Children's Hospital, Valencia, Spain.
Source
J Pediatr Gastroenterol Nutr, 1996 Jul, 23:1, 29-33

Abstract
One hundred forty-one children with insulin-dependent diabetes mellitus were screened for serum immunoglobulin A (IgA) antigliadin antibodies by means of an enzyme-linked immunosorbent assay (ELISA) method. None of them had gastrointestinal symptoms, and no major nutritional disturbances were detected except for a girl with moderate growth delay. Twelve patients with positive IgA antigliadin antibodies on two or more consecutive measurements underwent a small intestinal biopsy; four of them had a subtotal villous atrophy, and celiac disease was diagnosed; in another patient, a partial villous atrophy was observed. Children suffering from both diabetes and celiac disease showed an onset of diabetes at a younger age than did nonceliac patients. Prevalence of celiac disease in the screened population is 2.85%, which is higher than in the general population of the Comunidad Valenciana (one in 2,500 live births).

Preliminary results from follow-up of a large-scale population survey of antibodies to gliadin, reticulin and endomysium.

Author
Johnston SD; Watson RG; McMillan SA; McMaster D; Evans A
Address
Department of Medicine, Queen's University of Belfast, Northern Ireland.
Source
Acta Paediatr Suppl, 1996 May, 412:, 61-4

Abstract
Coeliac disease is often under-diagnosed, particularly in cases which are atypical or asymptomatic. OBJECTIVE: The aim of this study was to comprehensively assess the prevalence and clinical profile of adult coeliac disease in our community. METHODS: One-hundred-and-thirteen subjects from the most recent MONICA (multinational MONItoring of trends and determinants in Cardiovascular disease)1991/2 survey with positive serology were followed up 3 years after initial screening and assessed by means of (i) a clinical questionnaire, (ii) screening blood tests, and (iii) jejunal biopsy. RESULTS: Forty-six subjects (21 male, mean age 51 years) have been followed up to date. Prior to follow-up, two of these subjects were diagnosed as having coeliac disease. Ten (3 male, mean age 51 years) of 44 subjects had enteropathy. Three of these 10 subjects were relatively asymptomatic, 3 had folate deficiency and 3 had iron deficiency. Thus 12 of the 1823 initially screened had enteropathy consistent with coeliac disease. CONCLUSIONS: Coeliac disease is more prevalent than previous estimations and was found to be at least 1 in 152.

Diagnostic value of various serum antibodies detected by diverse methods in childhood celiac disease.

Author
Sacchetti L; Ferrajolo A; Salerno G; Esposito P; Lofrano MM; Oriani G; Micillo M; Paparo F; Troncone R; Auricchio S; Salvatore; F
Address
Dipartimento di Biochimica e Biotecnologie Mediche, Universita Frederico II, Napoli, Italy.
Source
Clin Chem, 1996 Nov, 42:11, 1838-42

Abstract
The diagnostic performances of antiendomysium IgA detected on monkey esophagus and human umbilical cord smooth muscle, of antireticulin IgA, and of antigliadin IgA and IgG were calculated in 74 children with celiac disease (CD) or other gastrointestinal disorders. We also compared four methods for gliadin antibody detection. With a diagnostic specificity of 100%, diagnostic sensitivity was 94% for antireticulin IgA, 93% for antiendomysium IgA when detected on human umbilical cord smooth muscle, and 97% when detected on monkey esophagus. The diagnostic sensitivity for gliadin antibody was highest with an ELISA procedure, followed by fluorogenic detection (94% for IgG, 91% for IgA, 97% with IgA and IgG combined). Because of its high diagnostic sensitivity and ease and speed of use, the combined antigliadin IgG and IgA antibody assay is suitable for screening large groups of patients. In IgG- or IgA-positive cases, the more demanding and more specific antiendomysium IgA evaluation is required to confirm suspected CD.

Serum and salivary antigliadin antibodies and serum IgA anti-endomysium antibodies as a screening test for coeliac disease.

Author
Rujner J; Socha J; Barra E; Gregorek H; Madali?ski K; Wo?niewicz B; Giera B
Address
Department of Gastroenterology, Child Health Centre, Warsaw, Poland.
Source
Acta Paediatr, 1996 Jul, 85:7, 814-7

Abstract
Serum and salivary IgA and IgG antigliadin antibodies were determined by an enzyme-linked immunosorbent assay in 18 children with villous atrophy and 30 children on a gluten-free diet for coeliac disease in whom normal intestinal mucosa was found. Serum IgA anti-endomysium antibodies were also determined by an immunofluorescence method in these children. Serum IgG antigliadin and IgA anti-endomysium antibodies had the highest sensitivity (100 and 94.4%, respectively), followed by serum IgA antibodies to gliadin (72.2%), salivary IgA antigliadin (61.2%) and IgG antigliadin (50%) antibodies. The highest specificity was found for serum IgA anti-endomysium (100%) and IgA antigliadin (96.6%) antibodies and salivary IgA and IgG antigliadin antibodies (93.3%), while serum IgG antigliadin antibodies were found to be least specific (63.3%).

Is small bowel biopsy necessary in adults with suspected celiac disease and IgA anti-endomysium antibodies? 100% positive predictive value for celiac disease in adults.

Author Valdimarsson T; Franzen L; Grodzinsky E; Skogh T; Str?m M
Address
Source
Abstract

IgA and IgG binding components of wheat, rye, barley and oats recognized by immunoblotting analysis with sera from adult atopic dermatitis patients.

Author

Varjonen E; Kalimo K; Savolainen J; Vainio E
Address
Department of Dermatology, Helsinki University Central Hospital, Finland.
Source
Int Arch Allergy Immunol, 1996 Sep, 111:1, 55-63
Abstract
IgA and IgG antibody response of adult atopic dermatitis patients against neutral/ acidic fractions of wheat, rye, barley and oats was analyzed utilizing an immunoblotting method. Moreover, the antibody response against ethanol-soluble fraction of wheat was examined with serum pools of healthy donors, atopic dermatitis patients and patients with dermatitis herpetiformis or adult celiac disease. All patient sera revealed polymorphic IgA and IgG binding to cereal peptides with molecular weights of 11-97 kD. The antibody staining was essentially identical with atopic dermatitis patients and controls. Patients with dermatitis herpetiformis or celiac disease showed more intensive staining with the ethanol extract of wheat and showed more IgA-stained bands in immunoblotting. It seems that the presence of IgA and IgG antibodies to different cereal antigens is a result of natural exposure and in atopic dermatitis displays little diagnostic significance, in contrast to antigliadin antibody response in dermatitis herpetiformis and celiac disease.

Measurement of sugar probes in serum: an alternative to urine measurement in intestinal permeability testing.

Author

Fleming SC; Duncan A; Russell RI; Laker MF
Address
Department of Clinical Biochemistry, University of Newcastle upon Tyne, UK.
Source
Clin Chem, 1996 Mar, 42:3, 445-8

Abstract
The percentage dose of lactulose and mannitol excreted in urine after oral ingestion is used as a noninvasive method of assessing small intestinal permeability. The collection of incomplete or inaccurately timed urine samples can lead to errors in estimation of sugar probe molecules. We describe an HPLC method for the simultaneous determination of lactulose and mannitol in serum after oral ingestion of test sugars. We applied the test to healthy volunteers and to subjects undergoing jejunal biopsy for suspected gluten-sensitive enteropathy. The ratio of concentrations of lactulose and mannitol in serum discriminated well between subjects with a normal biopsy and those with villous atrophy, discrimination being best at 90 min postdose. The results agree well with lactulose:mannitol ratios determined in urine (r= 0.88), and the two methods can be used interchangeably. The determination of mannitol and lactulose in serum provides an acceptable alternative to urine collection and may be particularly useful in young children. It also reduces the time spent on the investigation from 5 h to 90 min.

Recommendations: The Alpha Nutrition Program is gluten-free and is recommended as the diet revision strategy for anyone with diagnosed celiac disease, or any person with symptoms suggestive of gluten allergy.

Celiac Nutritional Rescue