Is small bowel biopsy necessary in adults with suspected coeliac disease and IgA anti-endomysium antibodies?

Valdimarsson, Trausti; Franzén, Lennart; Grodzinsky, Ewa; Ström, M.

doi:10.1097/00042737-199604000-00025

Cited by 5 publications

(5 citation statements)

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“…Four out of our 102 patients studied (4%) had findings suspected for CD, 2/88 with IgAN (2%), although none of them had verfied celiac disease. The frequency of CD was as a result not significantly elevated in Comparison to that of our historical controls (7/49 small bowel biopsied patients out of 58/1866 IgA-AGA positives) (about 0.4%) (13,37) and that which other studies have found in healthy adults (17).…”

Section: Discussioncontrasting

confidence: 57%

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Increased Prevalence of Anti-Gliadin IgA-Antibodies with Aberrant Duodenal Histopathological Findings in Patients with IgA-Nephropathy and Related Disorders

Almroth¹,

Axelsson²,

Müssener³

et al. 2006

Upsala Journal of Medical Sciences

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Section: Discussioncontrasting

confidence: 57%

“…The variations in the sensitivity and specificity of AGA have been shown to be 53-80% and 82-96%, respectively. The respective figures for EmA are 71-89% and 97-100% (13,14,37).…”

Section: Discussionmentioning

confidence: 98%

Increased Prevalence of Anti-Gliadin IgA-Antibodies with Aberrant Duodenal Histopathological Findings in Patients with IgA-Nephropathy and Related Disorders

Almroth¹,

Axelsson²,

Müssener³

et al. 2006

Upsala Journal of Medical Sciences

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“…The diagnostic sensitivity, of about 75% in adults [13] is too low to be useful and some authors have reported the specificity to be only 20% [14, 15]. Antibodies against endomysium (EmA) have a higher sensitivity, about 85–98% [16–19] and a very good specificity [17, 20, 21]. However, the interpretation of the endomysial immunoflourescence pattern is subjective and oesophagal tissue from monkeys is most commonly used.…”

Section: Introductionmentioning

confidence: 99%

Antibody levels in adult patients with coeliac disease during gluten‐free diet: a rapid initial decrease of clinical importance

Midhagen

Åberg

Olcén

et al. 2004

Journal of Internal Medicine

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“…The high positive 3 predictive value of a positive EMA result has led some authors to question the need for diagnostic jejunal biopsy in symptomatic patients with positive IgA EMA. 3 A positive IgA EMA in such patients may well herald development of coeliac disease in the future. If diagnostic jejunal biopsy is to be replaced by EMA, then due consideration should also be given to the negative predictive value of this test in excluding coeliac disease.…”

Section: Discussionmentioning

confidence: 99%

Audit of the Clinical Utility of Antibodies to Endomysium and Gliadin as Markers of Coeliac Disease

1998

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The diagnosis of coeliac disease is dependent on the demonstration of gluten sensitive small bowel enteropathy.' Circulating antibody markers for coeliac disease are a useful adjunct in the selection of patients for biopsy as well as in subsequent monitoring of compliance with a gluten free diet.2 As a result of increased awareness of the protean manifestations of coeliac disease and the consequences of misdiagnosis, immunology laboratories are receiving an increasing number of requests for coeliac disease antibody screening. There is much information on the clinical utility of antibody markers in selected patient populations attending gastroenterology clinics. However, there is limited information on the performance of coeliac antibodies for unselective screening of hospital patients. We report the results of an audit project conducted over a period of 18 months in a teaching hospital immunology laboratory. METHODSOver an 18-month period we audited a consecutive unselected group of 480 patients referred for a coeliac disease screen. Demographic and clinical details including history of abdominal pain, diarrhoea, weight loss, arthralgia, family history of coeliac disease and IgA deficiency were requested by questionnaire. The gold standard for the diagnosis of coeliac disease was taken as a small bowel biopsy demonstrating villous atrophy.Endomysial antibodies (EMA) were detected by standard indirect immunofluorescence performed on unfixed sections of monkey oesopha- RESULTSFrom the following specialties 275/480 questionnaires were returned (response rate 57.3%): paediatrics 137; gastroenterology 33; haematology 38, and general medicine 67. Of the 275 patients 72 (56 adults, 16 children) underwent small intestinal biopsy yielding 28 biopsy-proven cases of coeliac diseases. The 203 patients who did not undergo biopsy included 185 patients negative for both EMA and AGA and 18 patients positive for only AGA. Table 1 shows the sensitivity, specificity and positive and negative predictive values of our results (based on 72 cases biopsied) in comparison to two other larger studies based on 144 and 96 patients, respe~tively.~,~ Despite the use of highly selected patient groups, these studies were chosen since they reported on the clinical utility of both antibody isotypes (IgG and IgA) of AGA and EMA. DISCUSSIONOverall, our results confirm the value of IgA EMA as a highly sensitive and specific marker of untreated coeliac disease. The high positive 436

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Is small bowel biopsy necessary in adults with suspected coeliac disease and IgA anti-endomysium antibodies?

Cited by 5 publications

References 0 publications

Increased Prevalence of Anti-Gliadin IgA-Antibodies with Aberrant Duodenal Histopathological Findings in Patients with IgA-Nephropathy and Related Disorders

Increased Prevalence of Anti-Gliadin IgA-Antibodies with Aberrant Duodenal Histopathological Findings in Patients with IgA-Nephropathy and Related Disorders

Antibody levels in adult patients with coeliac disease during gluten‐free diet: a rapid initial decrease of clinical importance

Audit of the Clinical Utility of Antibodies to Endomysium and Gliadin as Markers of Coeliac Disease

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