Document Detail

Reliance on serum endomysial antibody testing underestimates the true prevalence of coeliac disease by one fifth.
MedLine Citation:
PMID:  10720117     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although IgA endomysial antibody (EmA) is currently the serologic test of choice in selecting suspected coeliac patients for duodenal biopsies, false-negative cases have been reported and may be more common than previous studies suggest. We assessed the sensitivity of EmA for patients with biopsy-confirmed villous atrophy (VA). METHODS: We studied 89 patients without IgA deficiency for whom biopsy had not been primarily prompted by a positive EmA result. VA was graded as partial, subtotal, or total (PVA, STVA, TVA). Serum EmA was assayed with indirect immunofluorescence. RESULTS: The sensitivity of EmA for VA was 78% (69 of 89) and was similar for PVA (79%) and ST/TVA (77%). Only 4 of the 20 EmA-negative patients had increased serum IgA-class antigliadin antibody levels as measured with enzyme-linked immunosorbent assay. All seronegative patients who complied with dietary gluten exclusion responded clinically, with histologic improvement after 12 months in 8 (67%) of 12 patients who had follow-up biopsies. CONCLUSIONS: EmA-negative coeliac disease is common. Reliance on EmA testing to select patients for biopsy will result in significant underdiagnosis.
W Dickey; D F Hughes; S A McMillan
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Scandinavian journal of gastroenterology     Volume:  35     ISSN:  0036-5521     ISO Abbreviation:  Scand. J. Gastroenterol.     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-04-07     Completed Date:  2000-04-07     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0060105     Medline TA:  Scand J Gastroenterol     Country:  NORWAY    
Other Details:
Languages:  eng     Pagination:  181-3     Citation Subset:  IM    
Dept. of Gastroenterology, Altnagelvin Hospital, Londonderry, Northern Ireland.
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MeSH Terms
Autoantibodies / immunology*
Celiac Disease / diagnosis*,  diet therapy,  immunology
Fluorescent Antibody Technique, Indirect
Gliadin / immunology*
IgA Deficiency
Immunoglobulin A / blood*
Middle Aged
Muscle Fibers, Skeletal / immunology
Reg. No./Substance:
0/Autoantibodies; 0/Immunoglobulin A; 9007-90-3/Gliadin

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

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