The old and new tests for celiac disease: which is the best test combination to diagnose celiac disease in pediatric patients?

Abstract

Background: In the diagnosis of celiac disease (CD), serum assays for anti-endomysium (EMA) and anti-transglutaminase (anti-tTG) antibodies have excellent diagnostic accuracy. However, these assays are less sensitive in young pediatric patients. Recently, a new ELISA test using deamidated gliadin peptides (DGP) as antigen has proved to be very sensitive and specific even in pediatric patients. In addition, anti-actin IgA antibodies (AAA) is another test that can be used in CD patients because antibody concentrations correlate with the degree of villous atrophy. This study evaluated the clinical accuracy of anti-tTG, EMA, AGA, anti-DGP and AAA and the effectiveness of these in different combinations for diagnosing CD in a large cohort of pediatric patients. Methods: Sera of 150 children under 6 years of age were tested: 95 patients had a diagnosis of CD, while 55 patients who did not suffer from CD were used as controls. Anti-DGP IgA/IgG and AAA were assayed with ELISA kits, while anti-tTG IgA/IgG and AGA IgG/IgA were assayed using a quantitative fluoroimmunoassay. The EMA test was conducted by indirect immunofluorescence.

Correlation between antibodies and histology in celiac disease: Incidence of celiac disease is higher than expected in the pediatric population

“…These results are crucial and encouraging for medical practice, as they may lead to alternative future genetic analyses and the discovery of combinations with new candidate genes for CD. Recent studies have focused on ways to speed up the diagnosis of CD (37,38), but according to our study, biopsies remain necessary. Until we find a combination of diagnostic methods that are 100% reliable, we should continue to perform biopsies.…”

Antibodies Against Deamidated Gliadin Peptides and Tissue Transglutaminase for Diagnosis of Pediatric Celiac Disease

“…DGP has replaced antibodies against native gliadin (8) because of much better test characteristics. DGP has been proposed to be a good complement to tTG (9)(10)(11), especially in case of IgA deficiency (12).…”

Laboratory Diagnosis of Celiac Disease in Patients with Selective IgA Deficiency

“…believed to be as specific as IgA anti-TTG, but not as sensitive, complicating their use as the primary test (8). However, many of the published studies comparing IgA and IgG testing did not specifically target patients with selective IgA deficiency, and it is possible that the sensitivity of IgG tests is higher in such patients because IgG-producing plasma cells are more plentiful in their small intestines.…”