The diagnostic accuracy of serologic tests for celiac disease: A systematic review

Rostom, Alaa; Dubé, Catherine; Cranney, Ann; Saloojee, Navaaz; Sy, Richmond; Garritty, Chantelle; Sampson, Margaret; Zhang, Li; Yazdi, Fatemeh; Mamaladze, Vasil; Pan, Irene; MacNeil, Joanne; Mack, David; Patel, Dilip D.; Moher, David

doi:10.1053/j.gastro.2005.02.028

Cited by 507 publications

(444 citation statements)

References 63 publications

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“…The results of this study agree with this conclusion. However, IgA‐EMA as well as IgA‐tTG are regarded as both sensitive and specific markers for CD (Rostom et al., 2005; Sugai et al., 2006), and are presently used as standard screening tests. In contrast to this, Selva‐O'Callaghan et al.…”

Section: Discussionmentioning

confidence: 99%

Increased prevalence of celiac disease in idiopathic inflammatory myopathies

et al. 2017

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ObjectivesIdiopathic inflammatory myopathies (IIM) are often associated with other immune‐mediated diseases or malignancy. Some studies have reported a high frequency of celiac disease in IIM. The aim of this study was to investigate the prevalence of celiac disease, systemic inflammatory diseases, and malignancy in a cohort of IIM patients, and estimate the incidence of IIM in the county of Östergötland, Sweden.Material and MethodsWe reviewed medical records and analyzed sera from 106 patients, fulfilling pathological criteria of inflammatory myopathy, for the presence of IgA antibodies against endomysium and gliadin. Antibody‐positive patients were offered further investigation with small bowel biopsy or investigation for the presence of antibodies against antitissue transglutaminase (t‐TG). The patients were classified according to Bohan and Peter or Griggs criteria. The presence of celiac disease, systemic inflammatory, and malignant diseases was documented.ResultsFour of 88 patients classified as IIM (4.5%) had biopsy‐confirmed celiac disease, which is higher than the prevalence in the general population, detected with a similar screening procedure (0.53%). Thirty‐three patients (38%) had a systemic inflammatory disease and five (5.7%) a malignancy. The incidence of confirmed IIM in the county of Östergötland was 7.3 per million/year.ConclusionsThe results highlight the high frequency of associated inflammatory and malignant diseases and confirm an increased prevalence of celiac disease in IIM.

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Section: Discussionmentioning

confidence: 99%

Increased prevalence of celiac disease in idiopathic inflammatory myopathies

et al. 2017

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“…The current prevalence of CD in the Western countries is estimated at between 1:80 and 1:100 (16,(20)(21)(22)(23)(24). Identification of anti-tTG and EMA antibodies as a marker for CD has caused AGA to lose the diagnostic role they had held since the early 80s (25).…”

Section: Discussionmentioning

confidence: 99%

“…A diagnosis of CD is based on the typical signs and symptoms associated with the presence of specific antitTG or anti-endomysial autoantibodies (EMA) (12)(13)(14). AGA testing currently has little diagnostic significance, because the methods used to identify them present lower levels of sensitivity and specificity than tests for antitTG or EMA (15,16). However, AGA testing is still considered useful in patients under 5 years old who test negative for anti-tTG (17).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic efficacy of the ELISA test for the detection of deamidated anti‐gliadin peptide antibodies in the diagnosis and monitoring of celiac disease

Tonutti

Visentini

Picierno

et al. 2009

Clinical Laboratory Analysis

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Background and Aim: We evaluated the diagnostic performance of an ELISA test for anti-gliadin IgA and IgG antibodies, which uses synthetic deamidated gliadin peptides (anti-gliadin antibodies, AGAs) as coating; the results were compared with a test that uses extracted gliadin (AGAe). Methods: The study was conducted on the sera of 144 patients suffering from celiac disease (CD), including 20 patients with IgA deficiency and 9 who were following a gluten-free diet (GFD), and 129 controls. Results: In the 115 CD patients (without IgA deficiency), the sensitivity of AGAe IgA and IgG was 32.2 and 60.9%, whereas that of AGAs IgA and IgG was 59.1 and 72.2%. The specificity for AGAe IgA and IgG, and AGAs IgA and IgG was 93.8 and 89.9%, and 96.9% and 99.2%, respectively. Of the 20 patients with CD and IgA deficiency, 7 tested positive for AGAe IgG and 14 for AGAs IgG. The test using deamidated gliadin peptides performed better in terms of sensitivity and specificity than the AGA tests with extracted antigen. Conclusions: The very high specificity of the AGAs IgG test (99.2%) also suggests that patients who test positive with this assay require a thorough followup, even if the anti-tissue transglutaminase antibodies (anti-tTG) and anti-endomysial autoantibodies (EMA) assays are negative.

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“…Nonetheless, adult patients with mild or moderate mucosal changes are more frequently seronegative for tTGA/EMA than children [18]. In both children and adults, high titers of EMA and tTGA are found in patients with severely abnormal small bowel mucosa [10,[17][18][19][20][21][22]. Data on lesser degrees of villous atrophy in relation to EMA and tTGA are discordant, making the role of serology unclear when duodenal biopsy is not reliable for diagnosing CD with a certain degree of confidence.…”

Section: Discussionmentioning

confidence: 99%

“…In children, they are reported to have a sensitivity and specificity of above 95% [9,10]. It is a well-established fact that increased EMA and tTGA correlate with abnormal small bowel histopathology [11].…”

Section: Introductionmentioning

confidence: 99%

Serology in adults with celiac disease: limited accuracy in patients with mild histological lesions

et al. 2011

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Celiac disease (CD) is a gluten-triggered enteropathy, presenting with insidious clinical patterns. It can occasionally be diagnosed in asymptomatic subjects. Our aim was to define the relationship among symptoms at diagnosis, serological markers [tissue transglutaminase antibodies (tTGA), anti-endomysium antibodies (EMA) anti-actin antibodies (AAA)] and degree of mucosal damage. A total of 68 consecutive adult patients with CD were enrolled. Intestinal biopsies were scored according to the Marsh classification modified by Oberhuber: I-II minimal lesions or absent villous atrophy; IIIA partial villous atrophy; IIIB-C total villous atrophy (TVA). HLA-typing was done for all patients. No association between clinical presentation and severity of mucosal damage was found. Presence of EMA or tTGA was significantly associated with more severe mucosal damage (P \ 0.001). Of 12 patients, 11 with AAA were also positive for TVA. The severity of mucosal damage is the main factor governing the detectability of serological markers of CD. The sensitivity of serological testing is questionable in patients with minimal lesions.

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The diagnostic accuracy of serologic tests for celiac disease: A systematic review

Cited by 507 publications

References 63 publications

Increased prevalence of celiac disease in idiopathic inflammatory myopathies

Increased prevalence of celiac disease in idiopathic inflammatory myopathies

Diagnostic efficacy of the ELISA test for the detection of deamidated anti‐gliadin peptide antibodies in the diagnosis and monitoring of celiac disease

Serology in adults with celiac disease: limited accuracy in patients with mild histological lesions

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