Auteur Topic: Anti-Actin IgA Antibodies Identify Celiac Disease Patients with a Marsh 3 Intest  (gelezen 1109 keer)


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Anti-Actin IgA Antibodies Identify Celiac Disease Patients with a Marsh 3 Intestinal Damage among Subjects with Moderate Anti-TG2 Levels

Enrico Schirru,1 Fabrice Danjou,1 Lucia Cicotto,2 Rossano Rossino,1 Maria Doloretta Macis,1 Rosanna Lampis,1 Rita-Désirée Jores,1 and Mauro Congia2

1Department of Public Health, University of Cagliari, Cittadella Universitaria, Monserrato, 09045 Cagliari, Italy
2Gastroenterology Unit, Microcitemico Hospital, ASL8 Cagliari, Via Jenner, 09121 Cagliari, Italy
Received 30 April 2013; Revised 6 August 2013; Accepted 7 August 2013
Academic Editor: Mikihiro Fujiya

Copyright © 2013 Enrico Schirru et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A new diagnostic tool (algorithm-1) for coeliac disease (CD) permitting the diagnosis without performing the duodenal biopsy has been recently proposed by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). It combines symptoms associated with CD, high anti-transglutaminase type 2 antibody (anti-TG2) levels, anti-endomysium-IgA antibodies (EMA), and at-risk HLA. Our aims were (i) to evaluate retrospectively in 227 individuals (149 CD patients and 78 controls) the algorithm-1, (ii) to reduce the number of duodenal biopsies among CD patients for whom algorithm-1 is not applicable through the addition of antiactin IgA antibodies (AAA-IgA), and (iii) to evaluate prospectively algorithm-1 and AAA-IgA in 50 patients with suspected CD. Algorithm-1 identified 70 out of 149 CD patients with Marsh 3 lesions. Adding AAA-IgA to the remaining patients with anti-TG2 levels comprised between 4 and 10 times upper limit of normal (ULN) allowed the detection of further 20 patients with a Marsh 3 damage. In our prospective study, algorithm-1 identified 23 out of 50 patients, whilst further 7 were recognized adding AAA-IgA. We confirm that algorithm-1 may avoid the duodenal biopsy in many CD patients and underscores the usefulness of AAA-IgA in reducing the number of duodenal biopsies in patients with moderate anti-TG2 levels.

Table 1: Prevalence of the symptoms suggestive of CD in our retrospective (149 CD patients) and prospective (50 CD patients) studies.

5. Conclusions
Our findings confirm that the duodenal biopsy may be omitted in a significant number of CD patients by the application of algorithm-1. In addition, we show that positivity for AAA-IgA in children and adolescents with anti-TG2 antibody levels comprised between 4 and 10 times ULN may further reduce the number of duodenal biopsies.

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