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Is immunoglobulin A anti-tissue transglutaminase antibody a reliable serological marker of coeliac disease?

Authors :
Lock RJ
Stevens S
Pitcher MC
Unsworth DJ
Source :
European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2004 May; Vol. 16 (5), pp. 467-70.
Publication Year :
2004

Abstract

Background: Anti-tissue transglutaminase (tTG) antibody is being used increasingly as a diagnostic tool in the serological investigation of coeliac disease. However, positive predictive values of immunoglobulin A (IgA) anti-tTG for coeliac disease in prospective studies have been disappointing and false-positive results are reported.<br />Objective: To assess the clinical utility of cascade testing for anti-tTG and anti-endomysium antibody (AEA).<br />Patients: Two unselected retrospective cohorts from routine diagnostic investigation for possible gluten sensitive enteropathy: group 1 comprised 57 cases seropositive for anti-tTG and group 2 comprised 52 cases seronegative for anti-tTG. In both groups, all cases had also undergone small-intestinal biopsy.<br />Methods: Patients were assessed for the presence of IgA anti-tTG by enzyme-linked immunosorbent assay and for IgA AEA by immunofluorescence.<br />Results: The positive predictive value of IgA anti-tTG for biopsy-confirmed coeliac disease was 54%. The positive predictive value of dual positivity for anti-tTG and AEA was 97%. The negative predictive value of IgA anti-tTG was 100%.<br />Conclusions: The data presented here support the use of IgA anti-tTG as an initial screen for coeliac disease. Coeliac disease is unlikely when IgA anti-tTG is absent. However, many false-positive results are seen, and clinical utility and diagnostic efficiency are improved markedly if positive results are confirmed with the more accurate, but labour-intensive, AEA assay.

Details

Language :
English
ISSN :
0954-691X
Volume :
16
Issue :
5
Database :
MEDLINE
Journal :
European journal of gastroenterology & hepatology
Publication Type :
Academic Journal
Accession number :
15097038
Full Text :
https://doi.org/10.1097/00042737-200405000-00005