Deamidated Gliadin Peptide Antibodies as a Routine Test for Celiac Disease

Volta, Umberto; Granito, Alessandro; Parisi, Claudia; Fabbri, Angelo; Fiorini, E; Piscaglia, Maria; Tovoli, Francesco; Grasso, Valentina; Muratori, Paolo; Pappas, Georgios; Giorgio, Roberto De

doi:10.1097/mcg.0b013e3181c378f6

Cited by 98 publications

(78 citation statements)

References 26 publications

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“…This new procedure would reduce the number of tests required, thus providing an obvious advantage in terms of cost-efficiency (Figure 2). 90 Recent data have shown that IgA tTGA can be present in the intestine before the serum, thus predicting a forthcoming CD. 91 These antibodies, detected by direct immunofluorescence on frozen sections of duodenal biopsies, display a high sensitivity for potential CD (78-100%), but their specificity is low because they are also present in a high proportion of patients with autoimmune disorders (diabetes mellitus type 1) or inflammatory bowel disease and in some controls.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Celiac disease: diagnostic criteria in progress

2011

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Until a few years ago, celiac disease (CD) was thought to be a rare food intolerance that was confined to childhood and characterized by severe malabsorption and flat intestinal mucosa. Currently, CD is regarded as an autoimmune disorder that is common in the general population (affecting 1 in 100 individuals), with possible onset at any age and with many possible presentations. The identification of CD is challenging because it can begin not only with diarrhea and weight loss but also with atypical gastrointestinal (constipation and recurrent abdominal pain) and extra-intestinal symptoms (anemia, raised transaminases, osteoporosis, recurrent miscarriages, aphthous stomatitis and associated autoimmune disorders), or it could be completely symptomless. Over the last 20 years, the diagnostic accuracy of serology for CD has progressively increased with the development of highly reliable tests, such as the detection of IgA tissue transglutaminase and antiendomysial and IgG antideamidated gliadin peptide antibodies. The routine use of antibody markers has allowed researchers to discover a very high number of 'borderline' cases, characterized by positive serology and mild intestinal lesions or normal small intestine architecture, which can be classified as potential CD. Therefore, it is evident that the 'old celiac disease' with flat mucosa is only a part of the spectrum of CD. It is possible that serology could identify CD in its early stages, before the appearance of severe intestinal damage. In cases with a positive serology but with mild or absent intestinal lesions, the detection of HLA-DQ2 and HLA-DQ8 can help reinforce or exclude the diagnosis of gluten sensitivity.

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Section: Diagnostic Criteriamentioning

confidence: 99%

Celiac disease: diagnostic criteria in progress

2011

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“…48 Although AGA is not a specific test for NCGS because these antibodus are present in many other conditions, such as autoimmune liver diseases, irritable bowel syndrome, connective tissue disorders and even blood donors, for the time being, the positivity of these antibodies (especially at a high titers) in patients with suspected NCGS can contribute to this diagnosis. 52 AGA IgG disappeared in 19 of 20 patients with NCGS within 6 months of initiating a GFD, whereas they remained positive in about half of CD patients after gluten withdrawal. 1,53 It is reasonable to hypothesize that immunological memory might be active in celiac disease but not in NCGS.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness

et al. 2013

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Recently, the increasing number of patients worldwide who are sensitive to dietary gluten without evidence of celiac disease or wheat allergy has contributed to the identification of a new gluten-related syndrome defined as non-celiac gluten sensitivity. Our knowledge regarding this syndrome is still lacking, and many aspects of this syndrome remain unknown. Its pathogenesis is heterogeneous, with a recognized pivotal role for innate immunity; many other factors also contribute, including low-grade intestinal inflammation, increased intestinal barrier function and changes in the intestinal microbiota. Gluten and other wheat proteins, such as amylase trypsin inhibitors, are the primary triggers of this syndrome, but it has also been hypothesized that a diet rich in fermentable monosaccharides and polyols may elicit its functional gastrointestinal symptoms. The epidemiology of this condition is far from established; its prevalence in the general population is highly variable, ranging from 0.63% to 6%. From a clinical point of view, non-celiac gluten sensitivity is characterized by a wide array of gastrointestinal and extraintestinal symptoms that occur shortly after the ingestion of gluten and improve or disappear when gluten is withdrawn from the diet. These symptoms recur when gluten is reintroduced. Because diagnostic biomarkers have not yet been identified, a double-blind placebo-controlled gluten challenge is currently the diagnostic method with the highest accuracy. Future research is needed to generate more knowledge regarding non-celiac gluten sensitivity, a condition that has global acceptance but has only a few certainties and many unresolved issues.

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“…[12][13][14] Recently the use of deamidated gliadin peptide (DGP) tests has emerged. 15,16 DGP (in particular, the DGP IgG test) may identify celiac disease patients by negative tTG IgA and anti-endomysial IgA (EMA) tests, 17 especially IgA-deficient individuals. Almost all individuals with celiac disease are positive for human leukocyte antigen (HLA)-DQ2.5 or DQ8 genes.…”

Section: Introductionmentioning

confidence: 99%

Prevalence estimation of celiac disease in the general adult population of Latvia using serology and HLA genotyping

et al. 2015

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Background: Prevalence estimates for celiac disease (CD) depend on the method used. The role of deamidated gliadin peptide (DGP) and genetic testing in epidemiological studies and diagnostic settings of celiac disease (CD) has still to be established. Objectives: The objective of this article is to assess the prevalence of CD in Latvia by combining serological tests with DQ2.5/ DQ8 testing. Methods: A total of 1444 adults from a randomly selected cross-sectional general population sample were tested by ELISA for tTG IgA, DGP IgA and IgG antibodies (QUANTA Lite Õ , Inova Diagnostics Inc). Samples with tTG IgA !20U were tested for EMA IgA by indirect immunofluorescence assay, and all specimens with tTG IgA !15U were tested by QUANTA-Flash Õ chemiluminescent assays (CIA) (Inova Diagnostics Inc) for tTG IgA, DGP IgA and IgG. DQ2.5/8 was detected in individuals with any positive ELISA test and a subgroup of controls. Results: Forty-three individuals (2.98%; 95% CI: 2.10-3.86%) tested positive by at least one ELISA test; 41.86% of the serology-positive individuals (any test above the cutoff) were DQ positive. Six individuals (0.42%; 95% CI: 0.09-0.75%) were triple ELISA positive, and DQ2.5 or DQ8 was positive in all; 0.35% (95% CI: 0.05-0.65%) were tTG IgA and EMA positive. Two tTG IgA-negative cases were both DGP IgG and IgA positive, both being DQ positive; including them in the ''serologypositive'' group would increase the prevalence to 0.49% (95% CI: 0.13-0.85%). CIA tests revealed 2 tTG IgA-positive and EMA-negative cases with a positive genotype. DQ2.5 or DQ8 genotype was positive in 28.6% of the serology-negative population. Conclusions: Estimates of the prevalence of CD in Latvia based on the serogenetic testing approach range from 0.35% to 0.49% depending on the criteria used. There is a rationale for combining serological tests and DQ2.5/8 genotyping.

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Deamidated Gliadin Peptide Antibodies as a Routine Test for Celiac Disease

Cited by 98 publications

References 26 publications

Celiac disease: diagnostic criteria in progress

Celiac disease: diagnostic criteria in progress

Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness

Prevalence estimation of celiac disease in the general adult population of Latvia using serology and HLA genotyping

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