Serum IgA and IgG Gliadin Antibodies and Small Intestinal Mucosal Damage in Children

Abstract

Serum immunoglobulin (Ig) A and IgG gliadin antibodies were determined with a simple, rapid, and inexpensive method—diffusion‐in‐gel enzyme‐linked immunosorbent assay (DIG‐ELISA)—and the results were related to small intestinal mucosal morphology in 234 children suspected of having malabsorption. Fifty‐six of 58 children with flat intestinal mucosa had increased IgA and/or IgG gliadin antibody levels (sensitivity 97%). Fifty‐four of the 58 children had celiac disease (CD) (n = 25) or probable CD (n = 29). Four children with flat mucosa had cow's milk protein and/or soy protein intolerance and three of these had increased gliadin antibody levels. Seventeen percent of 132 children with normal intestinal mucosa had increased IgA and/or IgG gliadin antibody levels. IgA and IgG gliadin antibody levels decreased significantly in the celiac children on a gluten‐free diet and increased significantly after gluten challenge. Determination of serum IgA and IgG gliadin antibodies by means of DIG‐ELISA is a sensitive test for small intestinal mucosal damage in children. When malabsorption is suspected, we suggest that this assay be used to select children for a small intestinal biopsy. It is also very useful for the follow‐up of adherence to a gluten‐free diet and to determine the effect of gluten challenge in celiac children.