Endomysium antibodies are superior to gliadin antibodies in screening for coeliac disease in patients presenting supposed functional gastrointestinal symptoms

• Published in: Scandinavian journal of primary health care Vol. 18; no. 2; pp. 105 - 110
• Main Authors: Agréus, L, Svärdsudd, K, Tibblin, G, Lavö, B
• Format: Journal Article
• Language: English
• Published: United States Informa UK Ltd 2000; Taylor & Francis
• Subjects: Accuracy; Adult; Aged; Aged, 80 and over; Antibodies; Biopsy; Case-Control Studies; Celiac Disease - blood; Celiac Disease - diagnosis; Celiac Disease - immunology; Celiac Disease - pathology; Coeliac disease; Colonic Diseases, Functional - blood; Colonic Diseases, Functional - diagnosis; Colonic Diseases, Functional - immunology; Colonoscopy; Diagnosis; Female; Glutens - immunology; Humans; Immunoglobulin A - blood; Immunoglobulin G - blood; Intestine, Small - pathology; Male; Mass Screening - methods; Medicin och hälsovetenskap; Middle Aged; Myofibrils - immunology; Patients; Sensitivity and Specificity; Studies; Sweden
• ISSN: 0281-3432; 1502-7724
• DOI: 10.1080/028134300750018990

Objective - To study the accuracy of IgA- and IgG-gluten antibodies and endomysium antibodies as screening tools for endoscopy with small bowel biopsy for histologic diagnosing of coeliac disease. Design - Comparing serology with histologic examination - the ?gold standard? for diagnosing coeliac disease. Settings - 1. The municipality of Östhammar, Sweden. 2. The catchment area of the University Hospital, Uppsala, Sweden. Patients - 1. A random subsample (50 with dyspepsia, 50 with irritable bowel syndrome and 50 symptomless) of a representative sample from an adult Swedish general population (20-80 years; n=1260). 2. All patients with a diagnosis of coeliac disease admitted to the University Hospital in Uppsala, Sweden during the course of 10 months. Main outcome measures - The accuracy of IgA- and IgG-gluten antibodies and endomysium antibodies. Results - There were no significant correlations between IgA-gluten antibodies and IgG-gluten antibodies, on the one hand, and symptoms or symptom severity, on the other. Using duodenal biopsy results as the gold standard, IgA-gluten antibodies had a low specificity and IgG-gluten antibodies a low sensitivity, whereas endomysium antibodies had an excellent accuracy. Conclusion - Endomysium antibodies seem to be the screening test of choice. The load of diagnostic upper endoscopies would be considerably decreased compared to using gluten antibodies.