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Diagnostic accuracy of coeliac serological tests: a prospective study.

Abstract

OBJECTIVE

The best way to test serologically for coeliac disease (CD) remains controversial, with endomysial (EMA), transglutaminase (TTG), and gliadin antibodies (AGA) being assessed in various combinations with no apparent standardization. The objective of this study was to evaluate whether TTG-IgA+/-TTG-IgG could be used as a replacement for endomysial antibodies as a reliable screen for CD in patients presenting to a major Australian tertiary referral hospital for assessment of symptoms consistent with CD.

METHODS

Individuals referred for gastroscopic assessment of possible CD were prospectively evaluated by duodenal biopsy assessment. The following diagnostic methods were compared: dual-isotype transglutaminase (TTG-dual), combined-isotype transglutaminase (TTG-IgA+G), TTG-IgA, combined-isotype gliadin antibodies (AGA-IgA+G), AGA-IgA, and endomysial antibody assays. Clinical performance characteristics (sensitivity, specificity, area under the curve for receiver-operating characteristic analysis; AUROC) were assessed for all kits.

RESULTS

The correlation between transglutaminase kits was generally good, with the best transglutaminase kit demonstrating high correlation (r=0.86) with endomysial antibodies. A comparison of different types of endomysial antibody assays displayed variable diagnostic performance (sensitivity 61.90-68.42%; specificity 80.00-98.57%; AUROC 0.71-0.83). Sensitivity (90.48-92.31%), specificity (80.77-82.89%) and AUROC values (0.92-0.94) for dual-isotype transglutaminase kits displayed narrow ranges. AGA assays were less sensitive (AGA-IgA: 42.31-46.15%; AGA-IgG: 61.54%) and less specific (AGA-IgA: 85.09-87.73%; AGA-IgG: 82.46-84.09%). Dual-isotype transglutaminase testing was diagnostically equivalent to transglutaminase-IgA (AUROC 0.92 versus 0.91, P=0.33).

CONCLUSIONS

Our study suggests that transglutaminase screening (using the IgA+/-IgG isotype) is a sensitive and specific alternative to endomysial antibody testing in the serological assessment of CD. On the basis of our findings, AGA antibody testing no longer appears to be an essential part of the diagnostic strategy for adult CD.

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  • Authors+Show Affiliations

    ,

    Hunter Area Pathology Service (HAPS), John Hunter Hospital, Newcastle, NSW 2310, Australia. glenn.reeves@hnehealth.nsw.gov.au

    , , , , , , ,

    Source

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Autoantibodies
    Biomarkers
    Celiac Disease
    Child
    Enzyme-Linked Immunosorbent Assay
    Gliadin
    Humans
    IgA Deficiency
    Immunoglobulin A
    Immunoglobulin G
    Middle Aged
    Prospective Studies
    ROC Curve
    Reagent Kits, Diagnostic
    Sensitivity and Specificity
    Serologic Tests
    Transglutaminases

    Pub Type(s)

    Evaluation Studies
    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16607143

    Citation

    Reeves, Glenn E M., et al. "Diagnostic Accuracy of Coeliac Serological Tests: a Prospective Study." European Journal of Gastroenterology & Hepatology, vol. 18, no. 5, 2006, pp. 493-501.
    Reeves GE, Squance ML, Duggan AE, et al. Diagnostic accuracy of coeliac serological tests: a prospective study. Eur J Gastroenterol Hepatol. 2006;18(5):493-501.
    Reeves, G. E., Squance, M. L., Duggan, A. E., Murugasu, R. R., Wilson, R. J., Wong, R. C., ... Pollock, W. K. (2006). Diagnostic accuracy of coeliac serological tests: a prospective study. European Journal of Gastroenterology & Hepatology, 18(5), pp. 493-501.
    Reeves GE, et al. Diagnostic Accuracy of Coeliac Serological Tests: a Prospective Study. Eur J Gastroenterol Hepatol. 2006;18(5):493-501. PubMed PMID: 16607143.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diagnostic accuracy of coeliac serological tests: a prospective study. AU - Reeves,Glenn E M, AU - Squance,Marline L, AU - Duggan,Anne E, AU - Murugasu,Rajathurai R, AU - Wilson,Robert J, AU - Wong,Richard C, AU - Gibson,Robert A, AU - Steele,Richard H, AU - Pollock,Wendy K, PY - 2006/4/12/pubmed PY - 2006/7/22/medline PY - 2006/4/12/entrez SP - 493 EP - 501 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 18 IS - 5 N2 - OBJECTIVE: The best way to test serologically for coeliac disease (CD) remains controversial, with endomysial (EMA), transglutaminase (TTG), and gliadin antibodies (AGA) being assessed in various combinations with no apparent standardization. The objective of this study was to evaluate whether TTG-IgA+/-TTG-IgG could be used as a replacement for endomysial antibodies as a reliable screen for CD in patients presenting to a major Australian tertiary referral hospital for assessment of symptoms consistent with CD. METHODS: Individuals referred for gastroscopic assessment of possible CD were prospectively evaluated by duodenal biopsy assessment. The following diagnostic methods were compared: dual-isotype transglutaminase (TTG-dual), combined-isotype transglutaminase (TTG-IgA+G), TTG-IgA, combined-isotype gliadin antibodies (AGA-IgA+G), AGA-IgA, and endomysial antibody assays. Clinical performance characteristics (sensitivity, specificity, area under the curve for receiver-operating characteristic analysis; AUROC) were assessed for all kits. RESULTS: The correlation between transglutaminase kits was generally good, with the best transglutaminase kit demonstrating high correlation (r=0.86) with endomysial antibodies. A comparison of different types of endomysial antibody assays displayed variable diagnostic performance (sensitivity 61.90-68.42%; specificity 80.00-98.57%; AUROC 0.71-0.83). Sensitivity (90.48-92.31%), specificity (80.77-82.89%) and AUROC values (0.92-0.94) for dual-isotype transglutaminase kits displayed narrow ranges. AGA assays were less sensitive (AGA-IgA: 42.31-46.15%; AGA-IgG: 61.54%) and less specific (AGA-IgA: 85.09-87.73%; AGA-IgG: 82.46-84.09%). Dual-isotype transglutaminase testing was diagnostically equivalent to transglutaminase-IgA (AUROC 0.92 versus 0.91, P=0.33). CONCLUSIONS: Our study suggests that transglutaminase screening (using the IgA+/-IgG isotype) is a sensitive and specific alternative to endomysial antibody testing in the serological assessment of CD. On the basis of our findings, AGA antibody testing no longer appears to be an essential part of the diagnostic strategy for adult CD. SN - 0954-691X UR - https://www.unboundmedicine.com/medline/citation/16607143/Diagnostic_accuracy_of_coeliac_serological_tests:_a_prospective_study_ L2 - http://Insights.ovid.com/pubmed?pmid=16607143 DB - PRIME DP - Unbound Medicine ER -