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Association between serum levels of total IgA and IgA class endomysial and antigliadin antibodies: implications for coeliac disease screening.
Eur J Gastroenterol Hepatol 1997; 9(6):559-62EJ

Abstract

BACKGROUND

Patients with selective immunoglobulin A (IgA) deficiency and coeliac disease, an established association, lack serum IgA class antigliadin and endomysial antibodies (AGA, EmA). Diagnostic protocols relying on AGA and EmA to select patients for small bowel biopsies will not identify these patients.

OBJECTIVE

To determine whether total IgA should be routinely measured in patients, suspected of having coeliac disease as a supplementary screening test before biopsy.

DESIGN

Prospective measurement of IgA, AGA and EmA in patients undergoing small bowel biopsy for suspected coeliac disease.

PATIENTS

We studied 318 patients suspected of having coeliac disease. Sera from 1959 controls in a random population sample were assayed as controls.

RESULTS

Thirty-one (10%) patients had villous atrophy, of whom 27 (87%) had EmA. Five (2%) of the 318 patients had undetectable total IgA (< 0.07 g/l): two (40%) of these five had villous atrophy in the setting of negative EmA. Use of undetectable IgA as a selection criterion for small bowel biopsy as well as positive EmA would have improved sensitivity from 87% (27/31) for EmA alone to 94% (29/31), with a fall in positive predictive value from 100% (27/27) to 91% (29/32), but would have maintained high specificity and negative predictive value. Serum IgA was undetectable in 5 (4%) of 117 patients with AGA in the range 0-10 ELISA units (EU) compared with none of 201 with higher AGA (P = 0.007, Fisher's exact test). Compared with controls who had AGA 0-10 EU, patients were more likely to have undetectable IgA (5/117 (4%) vs. 3/706 (0.4%); P = 0.005). Overall, the median IgA in patients with AGA 0-10 EU was lower than for those with AGA > 10 EU (1.89 g/l, vs. 2.34 g/l, P < 0.001).

CONCLUSION

There is an association between IgA deficiency and low/negative EmA/AGA. Routine measurement of total serum IgA in patients suspected of having coeliac disease, either with EmA or where AGA is low, improves selection of patients for small bowel biopsy.

Authors+Show Affiliations

Department of Gastroenterology, Altnagelvin Hospital, Londonderry, UK.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

9222726

Citation

Dickey, W, et al. "Association Between Serum Levels of Total IgA and IgA Class Endomysial and Antigliadin Antibodies: Implications for Coeliac Disease Screening." European Journal of Gastroenterology & Hepatology, vol. 9, no. 6, 1997, pp. 559-62.
Dickey W, McMillan SA, McCrum EE, et al. Association between serum levels of total IgA and IgA class endomysial and antigliadin antibodies: implications for coeliac disease screening. Eur J Gastroenterol Hepatol. 1997;9(6):559-62.
Dickey, W., McMillan, S. A., McCrum, E. E., & Evans, A. E. (1997). Association between serum levels of total IgA and IgA class endomysial and antigliadin antibodies: implications for coeliac disease screening. European Journal of Gastroenterology & Hepatology, 9(6), pp. 559-62.
Dickey W, et al. Association Between Serum Levels of Total IgA and IgA Class Endomysial and Antigliadin Antibodies: Implications for Coeliac Disease Screening. Eur J Gastroenterol Hepatol. 1997;9(6):559-62. PubMed PMID: 9222726.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between serum levels of total IgA and IgA class endomysial and antigliadin antibodies: implications for coeliac disease screening. AU - Dickey,W, AU - McMillan,S A, AU - McCrum,E E, AU - Evans,A E, PY - 1997/6/1/pubmed PY - 1997/6/1/medline PY - 1997/6/1/entrez SP - 559 EP - 62 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 9 IS - 6 N2 - BACKGROUND: Patients with selective immunoglobulin A (IgA) deficiency and coeliac disease, an established association, lack serum IgA class antigliadin and endomysial antibodies (AGA, EmA). Diagnostic protocols relying on AGA and EmA to select patients for small bowel biopsies will not identify these patients. OBJECTIVE: To determine whether total IgA should be routinely measured in patients, suspected of having coeliac disease as a supplementary screening test before biopsy. DESIGN: Prospective measurement of IgA, AGA and EmA in patients undergoing small bowel biopsy for suspected coeliac disease. PATIENTS: We studied 318 patients suspected of having coeliac disease. Sera from 1959 controls in a random population sample were assayed as controls. RESULTS: Thirty-one (10%) patients had villous atrophy, of whom 27 (87%) had EmA. Five (2%) of the 318 patients had undetectable total IgA (< 0.07 g/l): two (40%) of these five had villous atrophy in the setting of negative EmA. Use of undetectable IgA as a selection criterion for small bowel biopsy as well as positive EmA would have improved sensitivity from 87% (27/31) for EmA alone to 94% (29/31), with a fall in positive predictive value from 100% (27/27) to 91% (29/32), but would have maintained high specificity and negative predictive value. Serum IgA was undetectable in 5 (4%) of 117 patients with AGA in the range 0-10 ELISA units (EU) compared with none of 201 with higher AGA (P = 0.007, Fisher's exact test). Compared with controls who had AGA 0-10 EU, patients were more likely to have undetectable IgA (5/117 (4%) vs. 3/706 (0.4%); P = 0.005). Overall, the median IgA in patients with AGA 0-10 EU was lower than for those with AGA > 10 EU (1.89 g/l, vs. 2.34 g/l, P < 0.001). CONCLUSION: There is an association between IgA deficiency and low/negative EmA/AGA. Routine measurement of total serum IgA in patients suspected of having coeliac disease, either with EmA or where AGA is low, improves selection of patients for small bowel biopsy. SN - 0954-691X UR - https://www.unboundmedicine.com/medline/citation/9222726/Association_between_serum_levels_of_total_IgA_and_IgA_class_endomysial_and_antigliadin_antibodies:_implications_for_coeliac_disease_screening_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=9222726.ui DB - PRIME DP - Unbound Medicine ER -