Document Detail


Association between serum levels of total IgA and IgA class endomysial and antigliadin antibodies: implications for coeliac disease screening.
MedLine Citation:
PMID:  9222726     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with selective immunoglobulin A (IgA) deficiency and coeliac disease, an established association, lack serum IgA class antigliadin and endomysial antibodies (AGA, EmA). Diagnostic protocols relying on AGA and EmA to select patients for small bowel biopsies will not identify these patients. OBJECTIVE: To determine whether total IgA should be routinely measured in patients, suspected of having coeliac disease as a supplementary screening test before biopsy. DESIGN: Prospective measurement of IgA, AGA and EmA in patients undergoing small bowel biopsy for suspected coeliac disease. PATIENTS: We studied 318 patients suspected of having coeliac disease. Sera from 1959 controls in a random population sample were assayed as controls. RESULTS: Thirty-one (10%) patients had villous atrophy, of whom 27 (87%) had EmA. Five (2%) of the 318 patients had undetectable total IgA (< 0.07 g/l): two (40%) of these five had villous atrophy in the setting of negative EmA. Use of undetectable IgA as a selection criterion for small bowel biopsy as well as positive EmA would have improved sensitivity from 87% (27/31) for EmA alone to 94% (29/31), with a fall in positive predictive value from 100% (27/27) to 91% (29/32), but would have maintained high specificity and negative predictive value. Serum IgA was undetectable in 5 (4%) of 117 patients with AGA in the range 0-10 ELISA units (EU) compared with none of 201 with higher AGA (P = 0.007, Fisher's exact test). Compared with controls who had AGA 0-10 EU, patients were more likely to have undetectable IgA (5/117 (4%) vs. 3/706 (0.4%); P = 0.005). Overall, the median IgA in patients with AGA 0-10 EU was lower than for those with AGA > 10 EU (1.89 g/l, vs. 2.34 g/l, P < 0.001). CONCLUSION: There is an association between IgA deficiency and low/negative EmA/AGA. Routine measurement of total serum IgA in patients suspected of having coeliac disease, either with EmA or where AGA is low, improves selection of patients for small bowel biopsy.
Authors:
W Dickey; S A McMillan; E E McCrum; A E Evans
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  9     ISSN:  0954-691X     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1997-09-03     Completed Date:  1997-09-03     Revised Date:  2009-10-16    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  559-62     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, Altnagelvin Hospital, Londonderry, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Autoantibodies / analysis*
Biopsy, Needle
Celiac Disease / immunology,  prevention & control*
Child
Confidence Intervals
Duodenum / immunology*,  pathology
Enzyme-Linked Immunosorbent Assay
Female
Gliadin / analysis,  immunology*
Humans
Immunoglobulin A / analysis*
Immunoglobulin G / analysis
Immunoglobulin M / analysis
Male
Mass Screening / methods*
Middle Aged
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Autoantibodies; 0/Immunoglobulin A; 0/Immunoglobulin G; 0/Immunoglobulin M; 9007-90-3/Gliadin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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