78 SEROLOGICAL SCREENING FOR CELIAC DISEASE: COMPARATIVE STUDY OF ANTI-GLIADIN AND ANTI-ENDOMYSIUM ANTIBODIES.

Abstract

Serological testing has been strongly recommended for screening patients with suspected gluten sensitive enteropathy. However, the optimal testing strategy and methodology are still unclear. Aim: To prospectively evaluate and compare the reliability of serum anti-gliadin (AGA) and anti-endomysium antibodies (EMA) in predicting the diagnosis of celiac disease. Methods: Sera was tested for IgA and IgG AGA by ELISA, and IgA EMA by immunofluorescence techniques in 99 pediatric patients suspected of celiac disease, referred for duodenal biopsy. The Iga AEA assay was assessed using monkey esophagus (EMAm) and human umbilical cord tissue (EMAu). Results: 27 of the 99 patients evaluated had celiac disease (ESPGAN criteria). One celiac patient was IgA deficient. Table Conclusions: As anticipated, the EMA assay was more specific. However, no test was definitively superior to the others, and all were imperfect. Overall, our results support the use of AGA for first screening in view of lower cost, and ease of interpretation. Furthermore, the quantitative nature of the AGA test allows for following disease activity and may be useful in monitoring adherence to a gluten free diet. Positive serological testing cannot be relied upon without confirmation by biopsy, since false positive results may be obtained with both AGA and EMA assays.