Auteur Topic: Anti-Gliadin Antibodies Identify Celiac Patients Overlooked by Tissue Transgluta  (gelezen 1836 keer)


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Hawaii J Med Public Health. 2013 September; 72(9 Suppl 4): 14–17.
©Copyright 2013 by University Clinical, Education & Research Associates (UCERA)

Anti-Gliadin Antibodies Identify Celiac Patients Overlooked by Tissue Transglutaminase Antibodies
Brian C Benson, MD,corresponding author Christopher J Mulder **), DO, and Jeffrey T Laczek, MD
**) Dit is de arts Chris Mulder van het VUmc Amsterdam

For patients with suspected celiac disease, the American Gastroenterological Association recommends initial screening with anti-tissue transglutaminase antibody (tTG) and confirmation testing with small bowel biopsy. However, at Tripler Army Medical Center we routinely screen patients with both tTG and anti-gliadin antibodies (AGA) in combination. The purpose of this study was to evaluate whether this dual screening method adds to the evaluation of patients with suspected celiac disease or results in more false-positive results than tTG screening alone. A retrospective chart review of all tTG and AGA screening serologies at Tripler Army Medical Center between September 2008 and March 2012 was performed. For patients with positive serologic testing, small bowel biopsy results or reasoning for deferring biopsy were investigated. tTG was found to have a higher positive predictive value for celiac disease than AGA, however AGA identified 5 patients (19% of biopsy confirmed celiac disease) that had a negative tTG and would not have been identified by tTG screening alone. Using AGA in combination with tTG should be considered if the goal of screening is to identify all patients with celiac disease, with the understanding that this strategy will generate more false positive tests and result in additional patients undergoing small bowel biopsy.

Table 1  Reported sensitivities and specificities of celiac screening antibodies

Figure 1  Flow chart of all studied patients

Table 2  Positive predictive value calculations for each screening serology

The first celiac serology, AGA IgA, was developed in the early 1980s and revolutionized the diagnostic process of celiac disease.8 Prior to serologic studies, there was no screening test for celiac disease other than clinical suspicion, which was confirmed by small bowel biopsy. Shortly after the development of AGA, other serologic tests were introduced including tTG, antideaminated gliadin peptide antibodies, and antiendomysial antibodies.9 Although we recognize the significance of antiendomysial and antideaminated gliadin peptide antibodies, they are not routinely performed at our institution and were not included in the study.
Screening for celiac disease is recommended      etc.etc.     

While tTG has a significantly higher positive predictive value than AGA antibodies, AGA antibodies do increase the number of patients identified with celiac disease compared to tTG alone. Based on the results of this study, we reject our initial hypothesis. Screening with tTG in combination with AGA appeared beneficial if the goal of serologic testing is to maximize the number of patients discovered with celiac disease. Close follow-up of patients with positive celiac serologies is needed to ensure that they have the opportunity to undergo small bowl biopsy.

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