IgA Antiendomysial Antibodies Research Articles

PWE-122 How reliable is serological testing in the diagnosis of coeliac disease?

IntroductionCoeliac disease is an autoimmune disorder of the small bowel with a prevalence as high as 1:100 in the UK and Ireland. The gold standard for diagnosis is to identify...

Chronic Diarrhea in Children

Chronic Diarrhea in Children

Tu1432 A Longitudinal Study of Clinical Parameters and Cytokine Profiles in IBS

Background: In western populations where there is a high prevalence of celiac disease (CD), serological and tissue markers were found to be more common in patients with irritable bowel syndrome (IBS) phenotype. While CD is believed to be uncommon in Chinese, there is a report from China suggesting that this association may also exist. Aim: To study the prevalence of celiac disease markers in patients with IBS criteria and of Chinese ethnicity from Singapore, where there has been increasing wheat consumption. Method: We explored this association in a cohort of ethnic Chinese patients with IBS by Rome III criteria, who had all undergone IgA anti-gliadin antibody (AGA) and IgA anti-endomysial antibody (EMA) serology testing and duodenal biopsies as part of their clinical workup. In addition, we recalled patients with positive serology for further test of human leukocyte antigens HLADQ2 and HLA-DQ8, which are known to be associated with celiac disease. Result: In 106 patients of Chinese ethnicity who fulfilled Rome III IBS criteria 16 (15.1%) were tested positive for AGA, and 7 (6.6%) had intra-epithelial lymphocytosis reported in duodenal biopsies. None of the patients was positive for EMA. The prevalence of intra-epithelial lymphocytosis (IEL) was numerically higher in patients with positive AGA than negative AGA serology, with 3 (18.8%) and 4 (4.4%) respectively (p=0.105). Similarly, villous atrophy was numerically more common in AGA positive than AGA negative group with 8(50%) and 30(33.3%) respectively (p=0.20). None of these patients had more than mild villous atrophy. The prevalence of Helicobacter pylori infection in AGA positive and AGA negative groups were 18.8% and 28.9% respectively (p=0.40). Nine of the 16 patients in the AGA positive group agreed to undergo HLA-DQ2/8 genotyping, and only 2 patients were positive for HLA-DQ8. These two HLA-DQ positive patients are sisters whose parents had emigrated from the northern part of China where the traditional dietary staple was wheat. Neither of them had villous atrophy, but one had IEL. The other 7 patients who were HLA-DQ2/8 genotype negative were descended from tribes in the southern part of China; one of the patients had concurrent systemic lupus erythematosus (SLE). Five of the 7 patients had villous atrophy, while two of the 7 patients had IEL. Conclusion: Our observations suggest that celiac disease could be present in some ethnic Chinese patients with IBS criteria. However there is a subset of Chinese patients with positive anti-gliadin serology who do not have the full histologic features for celiac disease and were HLA haplotype negative, suggesting that these patients could IBS associated with an immune sensitization to gluten not amounting to celiac disease.

Diagnostic Accuracy of IGA Anti-Tissue Transglutaminase Antibody Testing in Celiac Disease

Diagnostic Accuracy of IGA Anti-Tissue Transglutaminase Antibody Testing in Celiac DiseaseContemporary guidelines for the first-line diagnosis of celiac disease recommend determination of IgA anti-tissue transglutaminase antibodies or IgA antiendomysial antibodies, as well as total serum IgA antibodies. The aim of our study was to assess the validity and clinical significance of serological testing for IgA anti-tissue transglutaminase antibodies in the diagnosis of celiac disease, and to investigate the presence of malabsorption symptoms in celiac patients. IgA anti-tissue transglutaminase antibody testing was performed in 50 subjects with clinically suspected celiac disease (21 men and 29 women). All subjects underwent endoscopy with small intestine biopsy. Celiac disease was confirmed by histopathological findings in four subjects, whereas the IgA anti-tissue transglutaminase test was positive in three subjects. The IgA anti-tissue transglutaminase test showed sensitivity of 75% and specificity of 100%. There were significant differences between men with biopsy-confirmed and excluded celiac disease in the erythrocyte parameters MCV (96.5±7.7 vs. 78.6 ±11.3; p<0.05), MCH (36.9±4.6 vs. 25.9±4.9; p<0.01), and MCHC (382.5±16.3 vs. 326.9±19.1; p<0.005), as well as in the levels of total protein (47.5 ±16.3 vs. 68.3 ± 7.6; p<0.01) and albumins (24.6±9.5 vs. 42.1 ± 6.9; p<0.01). In addition, HDL-cholesterol levels were significantly lower in men with biopsy-confirmed celiac disease (0.42.±0.12 vs. 0.90±0.30; p<0.05). Our results show a high correlation between IgA anti-tissue transglutaminase testing and endoscopy with biopsy as the gold diagnostic standard.

Clinical importance of celiac disease in patients with recurrent aphthous stomatitis

Recurrent aphthous stomatitis is a common disease of the oral mucosa that is characterized by recurrent, painful ulcers of unknown etiology. The association between celiac disease and recurrent aphthous stomatitis has been evaluated in several studies, but variable results have been reported. The purpose of this study was to determine the prevalence of celiac disease in patients with recurrent aphthous stomatitis. The study group consisted of 82 patients, all of whom had a history of recurrent aphthous stomatitis. The control group included 82 patients who did not have aphthous stomatitis. Patients were screened for IgA anti-endomysial antibodies, IgG anti-endomysial antibodies, IgA anti-gliadin antibodies, and IgG anti-gliadin antibodies. Patients with positive serology underwent endoscopic biopsies of the duodenal mucosa. Patients in both groups were also questioned regarding gastrointestinal symptoms. One patient (1.2%) out of 82 in the study group was diagnosed with celiac disease by biopsy. Gastroesophageal reflux disease symptoms, heartburn and regurgitation were determined to be of higher incidence in the study group (p<0.001 and p<0.001, respectively). None of the 82 patients in the control group were diagnosed as having celiac disease. It is concluded that there is no apparent etiological link between recurrent aphthous stomatitis and celiac disease and that screening recurrent aphthous stomatitis patients for celiac disease has little clinical value. Additionally, regurgitation of gastric acid to the oral cavity may precipitate the formation of aphthous stomatitis.

Do Gastroenterologists Adhere to Diagnostic and Treatment Guidelines for Celiac Disease?

Our group hypothesized that significant variation exists between suggested clinical guidelines, the clinical practices of practicing gastroenterologists and academic experts in celiac disease (CD). We designed 4 CD vignettes comparing experts and practicing gastroenterologists. Practicing gastroenterologists (n=169) were surveyed during Digestive Disease Week 2009 and experts (n=22) answered e-mail surveys. Ratings for answers in each vignette was done using a 9-point RAND Appropriateness Scale (RAS) with endorsement defined as RAS score of 7 to 9. We also calculated the RAND "Disagreement Index" (DI) was calculated, with DI>1.0 indicated extreme variation. A total of 169 practicing gastroenterologists and 22 experts were included. Differences in all vignette answers were present. Differences were seen for use of IgA anti-endomysial antibodies (P=0.0241), human leukocyte antigen DQ2/8 testing (P=0.0325), gluten challenge (P<0.0001), and oat consumption (P<0.0001). There were differences in recommendations for biopsy review (P=0.0479) and management of dermatitis herpetiformis (P=0.0025). Experts consistently endorsed CD screening in patients with type 1 diabetes, Down and Turner syndromes, and relatives of CD patients compared with practicing physicians (P=0.0054, 0.0003, <0.0001, 0.0304). Experts endorsed CD screening for atypical presentations (delayed puberty, elevated transaminases, primary biliary cirrhosis, autoimmune hepatitis, and infertility). There is significant disagreement between nonexperts and experts in diagnosis and management of CD. Promotion of existing guidelines and further research is advised.

Are Immunoglobulin A Anti‐gliadin Antibodies Helpful in Diagnosing Coeliac Disease in Children Younger Than 2 Years?

The usefulness of immumoglobulin (Ig) A antibodies to gliadin (AGA-IgA) in addition to IgA anti-endomysium and tissue transglutaminase antibodies was evaluated in 4122 children younger than 2 years with a suspicion of coeliac disease (CD). Eight percent (312/4122) displayed IgA anti-endomysium and/or IgA anti-tissue transglutaminase, whereas 2.1% (85/4122) displayed only AGA-IgA. Clinical data were obtained for 62 of 85 children with isolated AGA-IgA, and 33 children underwent a duodenal biopsy. Histologically proven CD was established for 5 patients, whereas 57 children were diagnosed to experience other diseases. The systematic detection of AGA-IgA using native gliadin conferred no additional diagnostic benefit for the diagnosis of CD in children younger than 2 years of age, except for rare cases.

The Diagnostic Value of Serum IGG-Antigliadin, IGA Anti-Endomysial and IGA Anti-Tissue Transglutaminase Antibodies for Pediatric Celiac Disease

Background and Objective: Celiac disease is an autoimmune disorder, characterized by inflammation, villous atrophy, and crypt hyperplasia of the small bowel mucosa. In this study we considered and compared sensitivity and specificity of serological tests in patients with celiac disease.Materials and Methods: In this cross-sectional study we prospectively recruited children with suspected celiac disease. An intestinal biopsy specimen was obtained from all patients. Celiac disease diagnosed on the basis of histologic findings of Marsh classification. A serum sample was taken at the time of biopsy for serologic tests. Findings were analyzed using SPSS program, t-test, and chisquare tests.Results: Out of a total of 134 children in this study, seventy (52.21%) patients were boy and sixty four (47.8%) patients were girl. Celiac disease was diagnosed in 14 (10.4%) of the patients. In serologic tests, 11 patients (78.6%) were positive for antigliadin-Ab, 4 (28.6%) for anti tissuetransglutaminase Ab, and 9 (64.3%) for antiendomysial antibody. Sensitivity of antigliadin-Ab was 78.6% and its specificity was 95.9%. Sensitivity of anti tissue-transglutaminase Ab was 28% and its specificity was 95%. Sensitivity of antiendomysial Ab was 64% and its specificity was 96%.Conclusion: Positive serologic tests are supportive of the diagnosis in those with characteristic histopathologic changes on small intestinal biopsy. The best tests for this purpose are the IgA antiendomysial antibody or IgA anti tissue-transglutaminase, both of which are highly sensitive and specific.

PP5 PYLORIC PNEUMATIC DILATION FOR THE TREATMENT OF ANTRAL PEPTIC OBSTRUCTION IN A CHILD

tory, with a well-known experience in this field (UV), has carried out antibody tests. Methods: Thirty-three consecutive subjects (without IgA deficiency) including 16 patients with suspected CD (24.6±6.1 month age; 11 females) and 17 controls (20.8±5.5 month age; 5 females) were tested for IgA antiendomysial antibodies (EmA) by indirect immunofluorescence (IFL) on human umbilical cord substrates (home-made method) and for IgA tissue transglutaminase (tTG), IgG DGP and IgG and IgA antigliadin antibodies (AGA) by commercial ELISA kits from Eurospital (Trieste, Italy). Of the 16 patients with suspected CD, 12 had classical gastro-intestinal (GI) symptoms and the remaining 4 showed extra-intestinal signs. The control group included 7 subjects with GI diseases (eosinophilic esophagitis, functional constipation, acute diarrhea) and 10 with non-GI diseases (respiratory, neurological, neonatal infections, congenital malformations). Suspected CD and 4 out of 7 controls with GI symptoms underwent EGDS to obtain 4 duodenal specimens, evaluated by Marsh-Oberhuber classification [1]. Results: All the 16 suspected CD patients were positive for DGP, tTG and EmA. Duodenal biopsy confirmed CD diagnosis showing a villous atrophy (lesion type 3a-b-c). tTG and EmA were consistently negative in all the 17 controls studied, whereas DGP positivity was observed in five cases (two biopsied with a normal mucosa). Both IgG and IgA AGA identified a few number of CD patients.

Prevalence of Celiac Disease in Healthy Turkish School Children

Epidemiological studies of celiac disease (CD) in Turkey have been performed only within some regions of the country. The aim of this study was to determine the prevalence of CD in Turkish school children. Between 2006 and 2008, serum samples were collected from 20,190 students (age range, 6-17 years) in 139 schools in 62 cities from different regions of Turkey. CD was screened using IgA antitissue transglutaminase (IgA-tTG) and total serum IgA. Subjects with selective IgA deficiency were further tested for IgG-tTG. Serum samples positive for IgA or IgG-tTG were further tested for IgA antiendomysial antibodies (IgA-EMAs) using an indirect immunofluorescence method. Small-intestinal biopsy was offered to all subjects with tTG antibody positivity. Of the 20,190 subjects, 489 were antibody positive (IgA-tTG only in 270, both IgA-tTG and IgA-EMA in 215, and IgG-tTG in 4). Selective IgA deficiency was detected in 108 patients, and 4 of them were positive for IgG-tTG. An intestinal biopsy was conducted in 215 subjects (IgA-tTG positive in 110, IgA-tTG and IgA-EMA positive in 104, and IgG-tTG positive in 1). The biopsy findings of 95 children were consistent with CD. Thus, the estimated biopsy-proven prevalence was 1:212 children. The positive predictive value (PPV) for IgA-tTG plus EMA was 75.9%. PPV was 44.3% when only IgA-tTG was used. We estimate that the prevalence of CD is at least 0.47% in healthy Turkish school children. Screening for IgA-tTG plus EMA provided better results for diagnosis when compared with testing for IgA-tTG alone.

Prevalence of asymptomatic celiac disease in children with fibromyalgia: a pilot study

BackgroundThe objective of this study was to prospectively determine the prevalence of asymptomatic celiac disease among children presenting with fibromyalgia. The secondary objective was to investigate if their symptoms resolved on a gluten free diet.FindingsAll children seen in the Amplified Musculoskeletal Pain clinic between the ages of 12 and 17 years of age who fulfilled the 1990 American College of Rheumatology diagnostic criteria for fibromyalgia were invited to participate. A total immunoglobulin A (IgA) level, IgA antiendomysial (EMA) and IgA anti-TTG antibodies was obtained on all study subjects. A visual analog scale for pain and a functional disability inventory were obtained on all patients. If a patient had elevated EMA or TTG a small bowel biopsy was done. Patients with celiac disease were placed on a gluten-free diet and observed to see if their symptoms resolved.50 patients, 45 females, completed the study. Only one patient was found to have celiac disease. On a gluten-free diet her tissue transglutaminase antibody level returned to normal but her visual analog scale scores increased and her functional disability inventory was 40 initially and 21 at follow up.ConclusionsIn this pilot, single center study at a tertiary children's hospital patients with fibromyalgia do not seem to have occult celiac disease at an increased rate over the population as a whole.

Assessment of a combination screening assay for celiac disease.

PurposeA serological screening assay for celiac disease (CD), designed to simultaneously detect IgA and IgG anti-tissue transglutaminase (a-tTG) and IgA and IgG deamidated gliadin peptide antibodies (a-DGP), was recently developed. In this study, we establish the performance of this assay.MethodsWe enrolled 41 CD patients and 18 CD patients on gluten-free diets. The diagnosis of CD was based on histological and serological criteria, including concomitant positive serology tests (a-tTG, IgA anti-endomysial antibodies). As control population, we enrolled 169 subjects: 145 disease controls and 24 blood donors. In all cases, serum samples were tested for: IgA a-tTG, IgG a-tTG, IgA a-DGP, IgG a-DGP, IgA anti-endomysial antibodies (EMA), IgA and IgG for a-tTG and a-DGP in a single assay.ResultsThe new test, QUANTA Lite ™ h-tTG/DGP Screen, detects all IgA and IgG antibodies against atTG and a-DGP present in a sample. In our study, the test showed 100% sensitivity and 91.12% specificity.ConclusionsThis study showed additional value of the new h-tTG/DGP Screen assay, which proved superior to more conventional assays and can be considered the best initial test for CD. Further studies are necessary to determine whether combination of h-tTG/DGP Screen with IgA a-tTG or IgA a-DGP can be used to obviate the need for duodenal biopsy in high- and low-risk populations

Predicción de lesión histológica intestinal en pacientes pediátricos con enfermedad celíaca

IntroductionSerological markers are of great interest in coeliac disease (CD), although intestinal biopsy is still the gold standard for establishing the diagnosis. Tissue transglutaminase IgA antibodies (AATGt-IgA) and antiendomysial antibodies IgA (AAE-IgA) are closely correlated to intestinal damage observed in biopsies. Villous atrophy (Marsh 3) plays a major role in CD diagnosis. Marsh 2 stage (crypt hyperplasia) as a CD marker is still under debate. ObjectiveTo ascertain an AATGt-IgA level that corresponds to a positive predictive value (PPV) of 100% for a histological CD diagnosis. Material and methodsA series of 120 patients younger than 14 years, non- IgA deficient, who underwent an intestinal biopsy and were positive for both serological markers (AATGt-IgA and AAE-IgA). For AATGt-IgA, according to the manufacturer's recommendations, a value greater than 16 IU/mL is considered as a positive value. The PPV of AATGt was determined for different cut-off points. ResultsThe histological findings distribution is directly correlated to the AATGt-IgA cut-off point. When the cut-off point is set above 7.5-10.6 times the commercial reference value, there is a 2.1% of Marsh 2 lessions and 93.4% of Marsh 3; above 10.6 times the reference value, all biopsies where Marsh 3 (100%). The PPV that considers Marsh 3 is (93.4%). The PPV, for considering Marsh 3 is low (55%) when AATGt-IgA serology is positive with levels between 16 and 67IU/ml (1-4.2 times the cut-off point) and a higher value (92%) for concentrations between 68 and 118IU/ml (4.3-7.4 times) and for cases with 69-170IU/ml (7.5-10.6 times); above 170 IU/ml (>10.6 times) PPV is 100%. ConclusionThe use of values higher than the recommended cut-off point must logically improve specificity and PPV. In 31.6% patients positive for AATGt-IgA and AAE-IgA (38/120) it would have been possible to diagnose the disease without intestinal biopsy as of the PPV was 100%. It is not possible to standardise results as there are different commercial kits with variable cut-off points, so we must be cautious when setting recommendations based on AATGt-IgA.

Estimation of (IgA) anti-gliadin, anti-endomysium and tissue transglutaminase in the serum of patients with psoriasis

Studies have indicated an association between psoriasis and coeliac disease (CD), an immune-mediated gluten-dependent enteropathy; however, the precise relationship between psoriasis and CD remains controversial. We aimed to assess the prevalence of the CD-associated IgA antibodies antigliadin antibody (AGA), tissue transglutaminase (tTG) and antiendomysium antibody (EMA) in patients with psoriasis. In total, 41 patients with psoriasis and 41 healthy controls were enrolled in this study. Blood samples were taken from all participants, and screened for AGA, tTG and EMA. We found a significantly higher level of AGA in patients with psoriasis than in controls, but levels of tTG and EMA were not significant. There was also a significantly higher prevalence of AGA, tTG and EMA in the patient group (34.1%, 34.1% and 14.6%, respectively) than in the control group (2.4%, 22% and 4.9%, respectively). We conclude that the significantly high prevalence of AGA antibodies in patients with psoriasis supports the possibility of a link between psoriasis and gluten-sensitive enteropathies, especially CD.

Latent celiac disease in reproductive performance of women

To investigate the prevalence of positive serologic findings for celiac disease in Indian women with poor reproductive performance. Cross-sectional except that the women with intrauterine growth restriction were followed prospectively until delivery. Department of Obstetrics and Gynecology of a tertiary teaching hospital, New Delhi. Eight hundred ninety-three women (104 women with idiopathic recurrent abortion, 104 women with unexplained stillbirth, 230 cases of unexplained infertility, 150 pregnant women with idiopathic intrauterine growth restriction, 305 control cases). None. The presence of antigliadin IgA and IgG, anti-tissue transglutaminase IgA by ELISA, and IgA antiendomysium antibody by indirect immunofluorescence microscopy. The seroprevalence of transglutaminase IgA was 6.70% in the group with recurrent abortion, 5.70% in the group with stillbirth, 5.65% in the group with infertility, 9.33% in the group with intrauterine growth restriction, and 1.30% in the control group. Rates of previous preterm births, low-birth-weight infants, and cesarean section were higher in seropositive women compared with seronegative subjects. Women having poor reproductive performance had subclinical celiac disease. The serology for celiac disease can be considered in idiopathic cases.

Sero-prevalence of Celiac Disease Among Healthy Adolescents in Kingdom of Saudi Arabia

Purpose: The aim of this study was to study the sero-prevalence of celiac disease among Saudi healthy adolescents. Methods: Between December 2007 and January 2008, healthy 10-12th grade school students were randomly selected in three regions in Saudi Arabia. These regions include: (1) Aseer region - having school population of 25,512, 13,996 males and 11,516 females; (2) Madinah - with school population of 23,852, 12,133 males and 11,719 females; and (3) Al-Qassim -with school population of 16,067, 7,974 males and 8,093 females. Demographic data were recorded, and a venous blood sample (5-10 mL) was taken from each student. Serum was separated by centrifugation, coded, and stored at -70 0C. The blood samples were tested for IgA anti-endomysium antibodies (EMA) by indirect immuno-fluorescence. Results: A total of 1167 students (614 males and 553 females) from these three regions were randomly selected. Twenty six (2.2%) healthy students had positive EMA, 17 females (3.1%) and 9 males (1.5%). Al-Qassim region had the highest CD prevalence among the 3 studies regions in Saudi Arabia (3.1%). Conclusion: On the basis of a high positive predictive value of the EMA antibody test, it is likely that the twenty six healthy students identified in this study have CD. These data suggest that CD prevalence is one of the highest in the world and that there is need for a large-scale epidemiologic study to determine the precise prevalence of the disease in Saudi Arabia.

Prevalence of serological markers for celiac disease (IgA and IgG class antigliadin antibodies and IgA class antiendomysium antibodies) in patients with autoimmune rheumatologic diseases in Belo Horizonte, MG, Brazil

Patients with autoimmune rheumatologic conditions and celiac disease tend to have a variety of autoantibodies, many of which have no clear pathogenic role. The literature contains frequent reports of celiac disease being more prevalent in patients with rheumatologic diseases, although this remains controversial. To investigate the prevalence of positive serum tests for celiac disease, particularly IgA and IgG antigliadin (AGA) antibodies and IgA antiendomysium antibodies (EmA) in patients with autoimmune rheumatologic diseases. A second aim was to correlate positive serum tests with prednisone and immunosuppressant medication. A total of 190 adults and pediatric patients with a variety of autoimmune rheumatologic diseases (systemic lupus erythematosus, rheumatoid arthritis, juvenile rheumatoid arthritis and spondyloarthrophathies) were evaluated and tested for IgA and IgG antigliadin-antibodies and IgA antiendomysium antibodies. Patients with positive serum tests underwent endoscopic duodenal biopsies for pathology studies. There were four positive sera (2.1%) for AGA IgA, all of which tested negative for AGA IgG and EmA. Three sera (1.6%) tested positive for AGA IgG; all were negative for AGA IgA and EmA. The EmA test at a 1:2.5 serum dilution tested positive in 94 patients (49.5%); at a 1:5 serum dilution it was positive in 41 patients (21.6%). Eleven subjects tested positive for EmA at 1:40 dilution; and all of these tested negative for IgA tissue antitransglutaminase (tTG) antibodies. Nine of the 11 EmA-positive patients and all 7 patients with positive antigliadin antibodies tests underwent duodenal endoscopic biopsies, and no significant changes were demonstrated in their duodenal mucosa. A positive EmA was associated with elevated optical density AGA IgA readings; however, there was no relationship between positive EmA and AGA IgG optical density readings. Prednisone and immunosuppressant use were unrelated to AGA IgA optical density readings or AGA IgG readings. These drugs were associated with fewer positive EmA tests. Positive AGAA, AGAG or EmA results are probably nonspecific for the presence of celiac disease among autoimmune rheumatologic disease patients. The intake of prednisone and immunosuprressant drugs seems to reduce the prevalence of IgA EmA, but it does not interfere with antigliadin antibodies tests.Further studies are required to estimate more accurately the prevalence of this disease in rheumatologic patients.

Diagnostic Testing for Celiac Disease Among Patients With Abdominal Symptoms

The symptoms and consequences of celiac disease usually resolve with a lifelong gluten-free diet. However, clinical presentation is variable and most patients presenting with abdominal symptoms in primary care will not have celiac disease and unnecessary diagnostic testing should be avoided. To summarize evidence on the performance of diagnostic tests for identifying celiac disease in adults presenting with abdominal symptoms in primary care or similar settings. A literature search via MEDLINE (beginning in January 1966) and EMBASE (beginning in January 1947) through December 2009 and a manual search of references for additional relevant studies. Diagnostic studies were selected if they had a cohort or nested case-control design, enrolled adults presenting with nonacute abdominal symptoms, the prevalence of celiac disease was 15% or less, and the tests used included gastrointestinal symptoms or serum antibody tests. Quality assessment using the Quality Assessment of Diagnostic Accuracy Studies tool and data extraction were performed by 2 reviewers independently. Sensitivities and specificities were calculated for each study and pooled estimates were computed using bivariate analysis if there was clinical and statistical homogeneity. Sixteen studies were included in the review (N = 6085 patients). The performance of abdominal symptoms varied widely. The sensitivity of diarrhea, for example, ranged from 0.27 to 0.86 and specificity from 0.21 to 0.86. Pooled estimates for IgA antiendomysial antibodies (8 studies) were 0.90 (95% confidence interval [CI], 0.80-0.95) for sensitivity and 0.99 (95% CI, 0.98-1.00) for specificity (positive likelihood ratio [LR] of 171 and negative LR of 0.11). Pooled estimates for IgA antitissue transglutaminase antibodies (7 studies) were 0.89 (95% CI, 0.82-0.94) and 0.98 (95% CI, 0.95-0.99), respectively (positive LR of 37.7 and negative LR of 0.11). The IgA and IgG antigliadin antibodies showed variable results, especially for sensitivity (range, 0.46-0.87 and range, 0.25-0.93, respectively). One recent study using diamidated gliadin peptides showed good specificity (> or = 0.94), but evidence is limited in this target population. Among adult patients presenting with abdominal symptoms in primary care or other unselected populations, IgA antitissue transglutaminase antibodies and IgA antiendomysial antibodies have high sensitivity and specificity for diagnosing celiac disease.

The Prevalence of Occult Celiac Disease among Patients with Functional Dyspepsia: A Study from the Western Region of Iran

Objective. The prevalence of Celiac Disease (CD) is high in Iran, and evaluation of CD is not part of the routine screening procedure for dyspeptic patients; therefore, cases of occult CD may be missed. This study aimed to investigate the prevalence of occult CD among dyspeptic patients who presented at a gastroenterology clinic in the Western region of Iran. Methods. In this descriptive, cross-sectional prospective study, patients who had a history of at least 12 weeks of upper abdominal discomfort were eligible to participate in the study during a 14-month recruitment period. Patients with a clinical or paraclinical data in favor of organic causes were excluded from the study. Enrolled patients were screened for IgA antiendomysium antibody (EMA) and IgA antitissue transglutaminase antibody (tTG). Those who screened positive for EMA/tTG received a confirmatory diagnostic biopsy for Marsh classification of CD. Results. From 225 potential participants with dyspepsia, 55 patients were excluded due to having explainable organic causes. The study sample included 170 patients with “functional dyspepsia.” Mean age of participants was 31 years and 55.8% were female. Twelve patients (7%) had positive tests (EMA/tTG), of which 10 were female (83.4%). According to Rome II criteria, all twelve patients with positive tests had “dysmotility type dyspepsia.” Based on Marsh classification, six patients were consistent with “Marsh I,” four with “Marsh II,” and two with the “Marsh III” classification. Conclusions. In this study, the prevalence of CD in dyspeptic patients was high. As a result, this study suggests that screening by serology tests (EMA/tTG) is justifiable for the detection of CD among functional dyspeptic patients in the tertiary centers in our country.

Other complications and associated conditions with diabetes in children and adolescents

aChildren’s Hospital auf der Bult, Hannover, Germany; bthe Children’s Hospital at Westmead, NSW, Australia; cUniversity of Helsinki, Finland; dMedical University Vienna, Austria; eUniversity of Genova, Italy; fUniversitat Ulm, Uni West, Germany; gUniversity of Sydney, Australia Corresponding author: Prof. Dr. med. Olga Kordonouri Diabetes Center for Children and Adolescents Children’s Hospital auf der Bult Hannover, Germany Tel: +49 511/8115-3340; fax: +49 511/8115-3334; e-mail: kordonouri@hka.de