Immunodiagnosis of Celiac Disease among Children with Chronic Diarrhea in Gaza Strip, Palestine

Abstract

Celiac disease (CD) is a permanent intolerance to gluten that results in damage to the mucosa of the small intestine. The prevalence of CD in developing countries may be undervalued due to different factors, but lack of awareness and low suspicion of the disease could be the main factors. The aim of the present work was to estimate the occurrence of CD among children suffering from chronic diarrhea in Gaza Strip and to adopt dependable non -invasive immunological techniques for diagnosis of CD in the laboratories of the Ministry of Health. This study was conducted on children (6-96 months) suffering from frequent (>3times/day) chronic diarrhea that not caused by infection. The study population comprised 123 symptomatic Palestinian children. Five ml peripheral blood were collected, sera were separated and stored at -70 ⁰C until performing the following assays: IgA Anti-endomysial antibodies(EMAs) using indirect immunofluorescence technique (IF), anti- tissue transglutaminase enzyme antibodies (tTG, IgG, IgA) and (tTG, IgA) using ELISA technique, anti smooth muscle antibodies (ASMA) using indirect immunofluorescence and total IgA using radial immunodiffusion (RID). The prevalence of CD using EMAs test was 3.25% but 12.2% when (tTG IgG, IgA) assay was applied. However, the prevalence of ASMA was 28.5% which may mask the EMAs antibodies and hence giving false negative results of EMAs. Our results showed comparable sensitivity of both (tTG IgG, IgA) and EMAs. Deficient or low IgA represented 33.3% of all (tTG IgG, IgA) positive samples. It was concluded that EMAs and (tTG IgG, IgA) tests could be used as noninvasive techniques on children suffering from CD. However for those having low or IgA deficiency, the class IgG of EMAs and tTG should be performed.