Endomysial antibody: is it the best screening test for coeliac disease?

Abstract

The sensitivities and specificities of the IgA and IgG antigliadin antibody and the IgA antireticulin antibody have been compared with the recently described endomysial antibody directed against the basement membrane of smooth muscle in monkey oesophagus. One hundred and seventeen patients with adult coeliac disease (21 untreated), 84 patients with inflammatory bowel disease, systemic lupus erythematosus and rheumatoid arthritis (comprising the disease control group), 47 normal controls and a miscellaneous group of 29 patients, who were selected because of a positive reticulin staining pattern, were investigated. These results were correlated with the degree of abnormality of the intestinal mucosa in patients with adult coeliac disease. Endomysial antibodies were found in all patients with untreated coeliac disease and subtotal villous atrophy and in 47% of patients on a non-strict gluten free diet. One patient on a strict gluten free diet was positive and had partial villous atrophy while all patients in disease control groups were negative. Results were variable with the antireticulin and antigliadin antibodies. Sensitivity and correlation with subtotal villous atrophy in the untreated patients was 100%. It is concluded that the endomysial antibody is superior to other current antibody tests and should be used in preference for the diagnosis of coeliac disease.

IgA anti-actin antibodies ELISA in coeliac disease: A multicentre study

“…The best serological approach to diagnose CD is based on the EmA and anti-tTG assays, which have a very high diagnostic accuracy [4][5][6]16,17]. However, these serological tests do not correlate with histopathological features [8,18] and only recently another test -the AAA assay -has been proposed as a marker of the severity of intestinal mucosa damage in CD [9,10].…”

“…It is nowadays evident that CD is one of the most common life-long diseases, with a frequency around 1:100-1:200 in the general population [1][2][3]. The enormous increase in CD diagnoses in recent decades is in large part due to the availability of serum tests with excellent diagnostic accuracy, such the anti-endomysium and antitransglutaminase assays [4][5][6]. However, these assays do not reflect the severity of the intestinal mucosa damage [7,8].…”

Antiendomysium antibodies in brazilian patients with celiac disease and their first-degree relatives

“…Our results show that EmA was 100% positive for untreated patients and for celiacs non-adhering to the diet and disagree with those reported by McMILLAN et al (50) who found that 89% of their patients with untreated celiac disease had a positive EmA measured by immunofluorescence. However, FERREIRA et al (26) showed 100% positivity to EmA for untreated celiac disease in a predominantly adult population similar to that studied here. The data of our study are in agreement with several authors from different countries, as can be seen in Table 4 (3,10,12,14,19,23,26,32,33,49,55,66,70) .…”

“…The use of these tests can result in a dramatic increase in the prevalence of CD because asymptomatic forms can be detected (65) . The sensitivities and specificities of these tests varied from centre to centre but improved with the use of class specific immunoglobulins (IgA) (26) .…”

Prevalence of celiac disease in Brazilian children of short stature

“…Antiendomysial antibody has been shown to have a high sensitivity and specificity for the diagnosis of celiac disease and correlates well with villous atrophy in untreated patients, but false-negative results have been obtained for patients with IgA deficiency, justifying its measurement (29)(30)(31)(32). However, an intestinal biopsy continues to be the Gold Standard for the diagnosis of celiac disease (6,7).…”