Serological testing for celiac disease in adults

Schyum, Astrid Collatz; Rumessen, Jüri Johannes

doi:10.1177/2050640613502788

Cited by 38 publications

(44 citation statements)

References 36 publications

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“…3 The most effective combination of immunoassays is TTG IgA and DGP IgG. 4 The antibody titers correspond with the degree of villous atrophy and in less destructive lesions are often lowlevel or negative. [6][7][8] Therefore, negative serology does not exclude diagnosis and if suspicion of CD is high, intestinal biopsy should be performed even if serology is negative.…”

Section: False Negative Resultsmentioning

confidence: 99%

“…This makes EMA less time and cost efficient compared to ELISA based TTG test. 4 Although these tests are both very effective, serology alone is not sufficient to confirm the diagnosis (at least in adult patients). 4 …”

Section: Serologic Testing For Celiac Diseasementioning

confidence: 99%

“…3,4 Another commonly used test is IgA anti-endomysial antibody (EMA), which is the most specific of all assays. 4 However, the latter test is technically more difficult, as it requires an immunofluorescence technique, which is a qualitative method; therefore, it is observer dependent and less objective. This makes EMA less time and cost efficient compared to ELISA based TTG test.…”

Section: Serologic Testing For Celiac Diseasementioning

confidence: 99%

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Diagnostic challenges in celiac disease

et al. 2017

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Diagnosis of celiac disease in adults is currently based on serologic tests in combination with histopathological assessment of small intestinal biopsy specimens. High titers of celiac-specific antibodies in immunocompetent patients with villous atrophy in a good quality biopsy sample allow us to state a confident diagnosis. The relief of symptoms and histological improvement after embarking on a gluten free diet further support the initial diagnosis. However, in some cases, these conditions are not fulfilled, which requires a critical evaluation of laboratory and histopathology results and a consideration of other potential causes for the observed pathologies. To avoid diagnostic uncertainty, both biopsy and laboratory testing should be performed on a diet containing gluten. Immune deficiency, cross reaction of antibodies and possibilities of seronegative or latent celiac disease should be considered while evaluating serology results. Uneven distribution and variable intensity of histopathological changes in the small intestine along with multiple disorders presenting a similar specimen image may lead to invalid biopsy results. Additional laboratory testing and careful examination of a patient's history may deliver important data for a differential diagnosis and a more specific biopsy evaluation. Persistence or recurrence of symptoms, despite the ongoing treatment, requires a revision of the initial diagnosis, an evaluation of the gluten free diet and a search for concurrent disorders or complications.

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Section: False Negative Resultsmentioning

confidence: 99%

Section: Serologic Testing For Celiac Diseasementioning

confidence: 99%

Section: Serologic Testing For Celiac Diseasementioning

confidence: 99%

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Diagnostic challenges in celiac disease

et al. 2017

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“…The performance of currently available methods for serological diagnosis of CD is very good [6]. For instance, the sensitivity and specificity of IgA anti-endomysial antibodies have been reported to be around 0.84 and 1.00, respectively.…”

Section: Radiology In Uncomplicated CDmentioning

confidence: 99%

“…For instance, the sensitivity and specificity of IgA anti-endomysial antibodies have been reported to be around 0.84 and 1.00, respectively. For IgA tissue transglutaminase (tTG) antibodies, the sensitivity and specificity have been reported to be around 0.93 and 0.95, respectively [6]. When combined, the diagnostic accuracy of serological tests may approximate 1.0.…”

Section: Radiology In Uncomplicated CDmentioning

confidence: 99%

Small Bowel Imaging in Celiac Disease

Weyenberg

Mulder²,

Waesberghe

2015

Dig Dis

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Background: Modern small bowel imaging techniques allow detailed depiction of small-intestinal abnormalities. The role of these techniques in the investigation of celiac disease is increasing, especially in patients with suspected complicated celiac disease. Key Messages: In general, there is no need for radiological small bowel imaging in uncomplicated celiac disease. It is however important that clinicians and radiologists are aware of certain specific radiological findings that may suggest celiac disease, especially since celiac disease is often not considered in adult patients, and small bowel radiology may be performed before specific tests for celiac disease. Radiological abnormalities can be observed with both conventional small bowel radiology studies, like small bowel follow-through or double-contrast small bowel enteroclysis, and newer modalities, like computed tomography or magnetic resonance enterography or enteroclysis. These signs include a decreased number of jejunal folds, an increased number of ileal folds, small bowel dilatation, wall thickening and intussusception. Extraintestinal abnormalities include mesenteric lymphadenopathy, vascular changes and splenic atrophy. Abnormalities congruent with refractory celiac disease type II include a severe decrease in jejunal folds, infiltration of the mesenteric fat and thickening of the small bowel wall. Additionally, a severely decreased splenic volume may indicate complicated celiac disease. Malignant complications of celiac disease, such as enteropathy-associated T-cell lymphoma and small-intestinal adenocarcinoma, can be reliably investigated with cross-sectional enteroclysis techniques. Conclusions: Small bowel imaging and especially cross-sectional enteroclysis techniques are important extensions to the diagnostic workup of clinicians involved in the care of patients with celiac disease, especially those with suspected complicated disease.

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Celiac Disease Autoimmunity and Hip Fracture Risk: Findings from a Prospective Cohort Study

Heikkilä

Heliövaara

Impivaara

et al. 2014

Journal of Bone and Mineral Research

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The impact of celiac disease autoimmunity on bone health is unclear. We investigated the associations of seropositivity for tissue transglutaminase antibodies (tTGA) and endomysial antibodies (EMA) with incident hip fractures using data from a prospective cohort study, Mini-Finland Health Survey. Baseline serum samples, taken in 1978-80, were tested for tTGA and EMA. Incident hip fractures up to the year 2011 were ascertained from a national hospitalization register. Associations between seropositivity and hip fractures were modeled using Cox proportional hazards regression adjusted for age, sex, body mass index, vitamin D, gamma-glutamyl transferase, smoking, and self-rated health. Our analyses were based on 6919 men and women who had no record of celiac disease or hip fracture before the study baseline. A total of 382 individuals had a hip fracture during a median follow-up of 30 years. Compared with the tTGAnegative individuals (n ¼ 6350), tTGA-positive participants (n ¼ 569; with hip fracture, n ¼ 51) had a higher risk of hip fractures (hazard ratio [HR] ¼ 1.59, 95% confidence interval [CI] 1.17, 2.14). The findings were similar for another tTGA test (n 200; with hip fracture, n ¼ 26; HR ¼ 2.23, 95% CI 1.49, 3.34). We found no evidence for an association between EMA positivity and hip fracture risk (HR ¼ 0.92, 95% CI 0.34, 2.47; n ¼ 74; with hip fracture, n ¼ 4). In our prospective population-based study of Finnish adults, seropositivity for tTGA was associated with an increased hip fracture risk.

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Serological testing for celiac disease in adults

Cited by 38 publications

References 36 publications

Diagnostic challenges in celiac disease

Diagnostic challenges in celiac disease

Small Bowel Imaging in Celiac Disease

Celiac Disease Autoimmunity and Hip Fracture Risk: Findings from a Prospective Cohort Study

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