Prospective Significance of Antiendomysium Antibody Positivity in Subsequently Verified Celiac Disease

Abstract

Endomysium antibody positivity at presentation has been found to be as useful as gluten challenge in the diagnosis of celiac disease, even in patients under the age of 2 years. Challenge is still advisable in patients with a flat small intestinal mucosa when antiendomysium antibody results are negative or have not been done, as among these patients significantly lower relapse rates were found.

Endomysial antibody-negative coeliac disease: clinical characteristics and intestinal autoantibody deposits

“…Some uncertainty often exists in the diagnosis of coeliac disease when serum EmA is negative, as villous atrophy can also be present in other disorders. [3][4][5] Also, the poor quality of biopsy specimens makes erroneous diagnosis possible. 28 In this study, none of the EmA-negative patients with coeliac disease were HLA DQ2 and DQ8 negative, and histological or clinical recovery on a GFD was shown.…”

“…4 5 In obscure cases, a histological or clinical response to a gluten-free diet (GFD) or a laborious and time-consuming gluten challenge is required to ascertain the diagnosis. 5 Although a positive serum EmA has a close to 100% specific association with coeliac disease, 6 approximately 10-20% of patients with untreated coeliac disease remain negative for serum EmA. 7 8 On the other hand, when patients with negative serum EmA and borderline histological lesions are treated with a GFD, there is always a possibility for a false diagnosis of coeliac disease.…”

Recombinant Human Tissue Transglutaminase for Diagnosis and Follow-Up of Childhood Coeliac Disease

“…These results indicate that measurements of anti-tTG antibodies can be used in the follow-up of diet compliance and GC. Korponay-Szabó et al (34) have proposed that GC could be advisable in some patients with initial villous atrophy and negative EMA results.…”

Immunoglobulin G (IgG) Anti-Tissue Transglutaminase Antibodies Used as Markers for IgA-Deficient Celiac Disease Patients

“…Additionally, the sensitivity was low, leaving a high number of cases of CoD undetected by this assay. IgG-EmA detection in IgA-deficient patients was equivalent to the IgA-EmA detection in subjects with normal serum IgA levels, despite the technical difficulties and subjective means of titer assessment associated with the immunofluorescence method (19,20). IgG-tTG measurement by an enzyme-linked immunosorbent assay (ELISA) based on guinea pig transglutaminase, on the other hand, has limited relevance for CoD (14,31).…”