Celiac disease (CD), an immune enteropathy caused by gluten-containing foods in genetically susceptible individuals, is usually diagnosed during childhood, but delayed diagnosis in adulthood is not uncommon (1 ). One-half of cases show atypical forms of the disease, e.g., irondeficient anemia unresponsive to iron or persistent hypertransaminasemia (2-4 ).Patients with CD often have high circulating concentrations of anti-endomysium antibodies (EMAs), the main disease marker (5 ), and anti-gliadin antibodies (AGAs), the most effective marker for children Ͻ3 years (6, 7 ). Tissue transglutaminase (tTG) has been identified as the autoantigen of CD (8 ).The first assays for tTG antibodies used antigen from guinea pigs (9 -15 ). Assays that used recombinant human tTg (rh-tTG) improved sensitivity and specificity (16 -21 ), but it is not well established in prospective studies whether the clinical effectiveness of rh-tTG is similar for children and adults.The aims of this study were (a) to evaluate the potential utility of rh-tTG IgA (rh-tTGA) compared with EMAs and AGAs for CD diagnosis in children and adults; (b) to analyze the concordance between rh-tTGA and small intestine biopsy (IB); and (c) to analyze the association of hypertransaminasemia and ferropenia with untreated CD.We prospectively selected 2570 patients with clinical suspicion of CD. Most patients (73.4%) were referred by the Pediatrics Department. From this cohort of patients we analyzed consecutively all patients fulfilling the inclusion and exclusion criteria. Inclusion criteria included histologic analysis of an IB and determination of serum markers for CD; the exclusion criterion was IgA deficiency. Both the IB and the immunologic markers were analyzed blindly and independently.The patients were classified into two groups. Group I consisted of 61 patients diagnosed with classic CD based on the results of the IB and obvious clinical and serologic response to a gluten-free diet. Group II contained 64 patients with clinical suspicion of CD but a normal IB and was considered the control group. The most common presentations in the control group were failure to thrive (29%) and gastrointestinal symptoms (27%).We also included 86 first-degree relatives of celiac patients, all asymptomatic. In this group we diagnosed six new cases of CD, who were then incorporated in group I.In our series 146 IBs were performed. Full-thickness jejunal biopsies were obtained by endoscopy or WatsonCrosby capsule (children). The histopathologic findings were classified according to internationally accepted criteria as normal mucosa, partial villous atrophy (slight, moderate, or severe), and subtotal villous atrophy (22 ). We considered all cases with at least a moderate villous atrophy as diseased, and biopsies showing slight atrophy or unspecific changes were considered as normal.rh-tTGA (expressed in the eukaryotic baculovirus system) was determined by enzyme immunoassay (Celikey; Pharmacia Diagnostics). The antibody concentration was expressed in arbitrary units (AU/mL)....

The Forrest classification is the principal predictive factor for an unfavorable course in patients with gastrointestinal bleeding owing to peptic ulcer, though clinical factors are also important and should complement the decision taking process.

Methods for the measurement of autoantibodies frequently provide controversial results. The objective of the present study was to evaluate the performance of Spanish Clinical Laboratories in the measurement of anti-Sm antibodies. A total of 23 laboratories participated, analysing 30 serum samples from patients with systemic lupus erythematosus and other autoimmune and non-autoimmune diseases. The laboratories used four extractable nuclear antigen screens, eight enzyme-linked immunosorbent assays (ELISAs) specific for anti-Sm, one line-blot, one dot-blot and one double immunodiffusion assay, from 15 different manufacturers. A total of 871 results were obtained. In general, very good sensitivity was obtained (95-100%), but specificity was moderate (52-86%) and must be improved. Most ELISAs and the line-blot were valid assays for anti-Sm detection and could serve as tests both for analysis and/or confirmation. The likelihood ratios indicated that both methods can be considered very useful or useful for the determination of anti-Sm antibodies. Nevertheless, the analytical quality of the methods for the measurement of anti-Sm antibodies could probably be improved by standardisation of the methods and the participation of laboratories in external quality control programs.

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