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Blood tests provide accurate diagnostic alternative to biopsy in coeliac disease

Researchers at Uppsala University in Sweden analysed whether the quantification of autoantibodies against tissue transglutaminase could be used to predict mucosal destruction and disease severity in patients with gluten sensitivity. (Whether a blood test could accurately identify the damage to the gut and the seriousness of the condition in people with gluten sensitivity.)

One hundred and seventy patients with coeliac disease (CD), comprising 52 children with severe malabsorption (group I), 59 children with mild symptoms (group II), 59 adults (group III), 134 patients with dermatitis herpetiformis (DH), and 131 disease controls, were studied.

Serial serum samples of patients in groups I and II on a gluten-free diet were also included. Serum levels of antibodies against recombinant tissue transglutaminase were determined with ELISA using standard curves for quantification of antibodies. Immunoglobulin (Ig)A antibodies against tissue transglutaminase (IgA-TGA) were detected in all of the patients with CD and in 95% of the DH patients.

The IgA-TGA and IgG-TGA levels were higher in group I (p <0.001). The IgG-TGA levels and positivity rate in group I (100%) were higher than in group II (81%), group III (73%), and the DH group (67%). Elevated IgA-TGA and IgG-TGA levels in combination predicted a more severe small intestinal atrophy (p <0.0001) with a specificity of 99% for Marsh IIIb-IIIc (flat) lesions.

The kinetics of the IgA-TGA decrease during diet differed between groups I and II. High levels of IgA-TGA and IgG-TGA antibodies were associated with the grade of mucosal villous atrophy and a more severe clinical presentation.

The researchers concluded that the combined measurement of IgA-TGA and IgG-TGA (in the blood) enables a noninvasive prediction of small intestinal villous atrophy with high accuracy (can accurately identify gut damage), and may reduce the need for a biopsy in patients with suspected CD.

Journal of Pediatric Gastroenterology and Nutrition
(Prediction of clinical and mucosal severity of coeliac disease and dermatitis herpetiformis by quantification of IgA/IgG serum antibodies to tissue transglutaminase. Journal of Pediatric Gastroenterology and Nutrition, 2010;50(2):140-6).

For additional information, contact I. Dahlbom, Paediatrics, Dept. of Women's and Children's Health, Uppsala University, Uppsala, Sweden.



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