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Positive tissue transglutaminase antibodies with negative endomysial antibodies: low rate of celiac disease.

Abstract

BACKGROUND

Screening for celiac disease is based on the sequential evaluation of serologic tests and intestinal biopsy; an optimal screening protocol is still under investigation. The screening policy of one of the main healthcare providers in Israel (Maccabi) consists of measuring total immunoglobulin A and tissue transglutaminase IgA antibodies and confirming positive results by endomysial antibodies. For IgA-deficient patients antigliadin IgG is measured.

OBJECTIVES

To evaluate the use of tTGA as a first-level screening test in patients suspected of having celiac disease

METHODS

The results of tTGA and EMA tests over a 3 month period were obtained from the laboratory computer. Letters were sent to the referring physicians of patients with positive tests, requesting clinical information and small intestinal biopsy results. tTGA was performed using an anti-guinea pig tTG-IgA enzyme-linked immunosorbent assay kit.

RESULTS

Overall, 2,505 tTGA tests were performed: 216 (8.6%) were tTGA-positive of which 162 (75%) were EMA-negative (group 1) and 54 (25%) EMA-positive (group 2.) Clinical information was obtained for 91 patients in group 1 and 32 in group 2. Small intestinal biopsy was performed in 33 (36%) and 27 patients (84%) in groups 1 and 2, respectively. Celiac disease was diagnosed in 4 biopsies (12%) in group 1 and 23 (85%) in group 2 (P < 0.0001). The positive predictive value was 45% for tTGA and 85% for EMA.

CONCLUSIONS

Symptomatic patients with positive tTGA and negative EMA have a low rate of celiac disease compared to those who are tTGA-positive and EMA-positive. Confirmation with EMA is advised when tTGA is performed as a first-level screening for suspected celiac disease.

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  • Authors+Show Affiliations

    ,

    Division of Pediatric Gastroenterology and Nutrition, Edmond and Lily Safra Children's Hospital, Israel. weissb@sheba.health.gov.il

    , , , ,

    Source

    MeSH

    Adolescent
    Adult
    Autoantibodies
    Bias
    Biomarkers
    Biopsy
    Celiac Disease
    Duodenum
    Enzyme-Linked Immunosorbent Assay
    Female
    Fluorescent Antibody Technique, Indirect
    Gliadin
    Humans
    Immunoglobulin A
    Immunoglobulin G
    Israel
    Male
    Mass Screening
    Prevalence
    Sensitivity and Specificity
    Transglutaminases

    Pub Type(s)

    Journal Article
    Validation Studies

    Language

    eng

    PubMed ID

    14740501

    Citation

    Weiss, Batia, et al. "Positive Tissue Transglutaminase Antibodies With Negative Endomysial Antibodies: Low Rate of Celiac Disease." The Israel Medical Association Journal : IMAJ, vol. 6, no. 1, 2004, pp. 9-12.
    Weiss B, Bujanover Y, Avidan B, et al. Positive tissue transglutaminase antibodies with negative endomysial antibodies: low rate of celiac disease. Isr Med Assoc J. 2004;6(1):9-12.
    Weiss, B., Bujanover, Y., Avidan, B., Fradkin, A., Weintraub, I., & Shainberg, B. (2004). Positive tissue transglutaminase antibodies with negative endomysial antibodies: low rate of celiac disease. The Israel Medical Association Journal : IMAJ, 6(1), pp. 9-12.
    Weiss B, et al. Positive Tissue Transglutaminase Antibodies With Negative Endomysial Antibodies: Low Rate of Celiac Disease. Isr Med Assoc J. 2004;6(1):9-12. PubMed PMID: 14740501.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Positive tissue transglutaminase antibodies with negative endomysial antibodies: low rate of celiac disease. AU - Weiss,Batia, AU - Bujanover,Yoram, AU - Avidan,Benjamin, AU - Fradkin,Akiva, AU - Weintraub,Ilana, AU - Shainberg,Bracha, PY - 2004/1/27/pubmed PY - 2004/2/10/medline PY - 2004/1/27/entrez SP - 9 EP - 12 JF - The Israel Medical Association journal : IMAJ JO - Isr. Med. Assoc. J. VL - 6 IS - 1 N2 - BACKGROUND: Screening for celiac disease is based on the sequential evaluation of serologic tests and intestinal biopsy; an optimal screening protocol is still under investigation. The screening policy of one of the main healthcare providers in Israel (Maccabi) consists of measuring total immunoglobulin A and tissue transglutaminase IgA antibodies and confirming positive results by endomysial antibodies. For IgA-deficient patients antigliadin IgG is measured. OBJECTIVES: To evaluate the use of tTGA as a first-level screening test in patients suspected of having celiac disease METHODS: The results of tTGA and EMA tests over a 3 month period were obtained from the laboratory computer. Letters were sent to the referring physicians of patients with positive tests, requesting clinical information and small intestinal biopsy results. tTGA was performed using an anti-guinea pig tTG-IgA enzyme-linked immunosorbent assay kit. RESULTS: Overall, 2,505 tTGA tests were performed: 216 (8.6%) were tTGA-positive of which 162 (75%) were EMA-negative (group 1) and 54 (25%) EMA-positive (group 2.) Clinical information was obtained for 91 patients in group 1 and 32 in group 2. Small intestinal biopsy was performed in 33 (36%) and 27 patients (84%) in groups 1 and 2, respectively. Celiac disease was diagnosed in 4 biopsies (12%) in group 1 and 23 (85%) in group 2 (P < 0.0001). The positive predictive value was 45% for tTGA and 85% for EMA. CONCLUSIONS: Symptomatic patients with positive tTGA and negative EMA have a low rate of celiac disease compared to those who are tTGA-positive and EMA-positive. Confirmation with EMA is advised when tTGA is performed as a first-level screening for suspected celiac disease. SN - 1565-1088 UR - https://www.unboundmedicine.com/medline/citation/14740501/Positive_tissue_transglutaminase_antibodies_with_negative_endomysial_antibodies:_low_rate_of_celiac_disease_ L2 - http://www.ima.org.il/IMAJ/ViewArticle.aspx?year=2004&amp;month=01&amp;page=9 DB - PRIME DP - Unbound Medicine ER -