Abstract
Celiac disease (CD), a genetic, immunologically mediated small bowel enteropathy that causes malabsorption, is one of the more common disorders in Western countries and is frequently underdiagnosed because of its protean presentations (1). Early diagnosis and treatment with a gluten-free diet may reduce the risk for nutritional (2), bone (3), and obstetric complications (4), as well as malignancies (5)(6) and increased mortality rates (7)(8). Histologic demonstration of a flat small intestinal mucosa, together with clinical improvement when patients are on a gluten-free diet, continues to be the gold standard for its diagnosis. The serologic detection of anti-endomysium antibodies (EmAs) is used to support the diagnosis and to screen populations at risk; the sensitivity and specificity of these tests are 70–95% and 100%, respectively (9). The identification of tissue transglutaminase (tTG) as the main antigen of EmAs (10) allows a new diagnostic approach to CD. A large number of ELISA methods, mainly based on commercially available guinea pig tTG, have been produced; however, these methods have a lower diagnostic accuracy than EmAs (11)(12)(13). Assuming that possible interspecies differences could be responsible for such discrepancies, the use of human tTG antigen was recently suggested (14). The first aim of this study was to clarify the diagnostic accuracy of four commercially available anti-human tTG-IgA ELISA methods in both controls and EmA-positive CD patients. The second aim was to compare anti-tTG results obtained by these different methods and their feasibility in practice. The study population consisted of 34 untreated, newly diagnosed, and ambulatory EmA-positive CD patients (26 women and 8 men; median age, 36 years; range 23–65 years) seen consecutively at the University Department of Internal Medicine between May and September 2000. The diagnosis was made in all cases by the typical histologic appearance …
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