Diagnostic radiology

ENDOMYSIAL ANTIBODIES: TO BIOPSY? FOLLOW? OR IGNOREPOSITIVE TISSUE TRANSGLUTAMINASE ANTIBODIES WITH NEGATIVE – מתוך כנס גאסטרו ילדים, 9 ביולי 2002

B. Weiss, Y. Bujanover, A. Fradkin, B. Shainberg.

Division of Pediatric Gastroenterology, Sheba Medical Center, Tel-Hashomer, and The Central Laboratory, Kupat-Holim Maccabi, Rehovot.

INTRODUCTION: Antibodies to tissue transglutaminse (TTGA) are reported to correlate with endomysial antibodies (EMA) in celiac disease (CD). However, there are discrepancies concerning the specificity and sensitivity of TTGA, and its use as a screening method for CD is still under investigation. The laboratory serving one of the main health services in Israel (Maccabi) has a screening policy for CD: initially TTGA is performed, and positive cases are confirmed by EMA. AIM: The aim of this study is to evaluate the sensitivity of TTGA as a screening test for symptomatic patients. METHODS: TTGA was performed using an anti-guinea pig tTG IgA ELISA kit. The results of TTGA and EMA tests over a 3-month period were obtained from the laboratory. Letters were sent to the referring physicians of patients with positive tests, requesting clinical symptoms and small bowel biopsy results, if performed. RESULTS: 2505 screening tests for celiac were performed during a 3 months period: 216 were TTGA positive (8.6%): 162 of them (75%) were EMA- (group 1), and 54 (25%) were EMA+ (group 2). Clinical information was obtained for 91 and 32 patients, in groups 1 and 2 respectively. Symptoms were similar in both groups. Small intestinal biopsy was performed in 33 patients (36%) and 27 patients (84%) in groups 1 and 2, respectively. Celiac disease was diagnosed in 4/33 (12%) biopsies in group 1, and 23/27 (85%) biopsies in group 2 (p<0.0001). The sensitivity of TTGA alone for diagnosis of celiac disease is 45%, compared to 85% for EMA (p<0.001). CONCLUSIONS: TTGA test performed with an anti-gp ELISA kit has a low sensitivity for celiac disease, and confirmation with EMA is needed. For patients with a TTGA+/EMA- test follow-up and repeat tests are recommended before intestinal biopsy is performed. Trials with anti-human tTG-IgA ELISA kit should be considered, to improve test sensitivity

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