+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Tests for Serum Transglutaminase and Endomysial Antibodies Do Not Detect Most Patients With Celiac Disease and Persistent Villous Atrophy on Gluten-free Diets: a Meta-analysis



Tests for Serum Transglutaminase and Endomysial Antibodies Do Not Detect Most Patients With Celiac Disease and Persistent Villous Atrophy on Gluten-free Diets: a Meta-analysis



Gastroenterology 153(3): 689-701.E1



Tests to measure serum endomysial antibodies (EMA) and antibodies to tissue transglutaminase (tTG) were developed to screen for celiac disease in patients consuming gluten. However, they are commonly used to monitor patients on a gluten-free diet (GFD). We conducted a meta-analysis to assess the sensitivity and specificity of tTG IgA and EMA IgA assays in identifying patients with celiac disease who have persistent villous atrophy despite a GFD. We searched PUBMED, EMBASE, BIOSIS, SCOPUS, clinicaltrials.gov, Science Citation Index, and Cochrane Library databases through November 2016. Inclusion criteria were studies of subjects with biopsy-confirmed celiac disease, follow-up biopsies, and measurement of serum antibodies on a GFD, biopsy performed on subjects regardless of symptoms, or antibody test results. Our analysis excluded subjects with refractory celiac disease, undergoing gluten challenge, or consuming a prescribed oats-containing GFD. Tests were considered to have positive or negative findings based on manufacturer cut-off values. Villous atrophy was defined as a Marsh 3 lesion or villous height:crypt depth ratio below 3.0. We constructed forest plots to determine the sensitivity and specificity of detection for individual studies. For the meta-analysis, a bivariate random effects model was used to jointly model sensitivity and specificity. Our search identified 5408 unique citations. Following review of abstracts, 442 articles were reviewed in detail. Only 26 studies (6 of tTG assays, 15 of EMA assays, and 5 of tTG and EMA assays) met our inclusion criteria. The most common reason studies were excluded from our analysis was inability to cross-tabulate histologic and serologic findings. The serum assays identified patients with persistent villous atrophy with high levels of specificity: 0.83 for the tTG IgA assay (95% CI, 0.79-0.87) and 0.91 for the EMA IgA assay (95% CI, 0.87-0.94). However, they detected villous atrophy with low levels of sensitivity: 0.50 for the tTG IgA assay (95% CI, 0.41-0.60) and 0.45 for the EMA IgA assay (95% CI, 0.34-0.57). The tests had similar levels of performance in pediatric and adult patients. In a meta-analysis of patients with biopsy-confirmed celiac disease undergoing follow-up biopsy on a GFD, we found that tests for serum tTG IgA and EMA IgA levels had low sensitivity (below 50%) in detection of persistent villous atrophy. We need more-accurate non-invasive markers of mucosal damage in children and adults with celiac disease who are following a GFD.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 060322123

Download citation: RISBibTeXText

PMID: 28545781

DOI: 10.1053/j.gastro.2017.05.015


Related references

Endomysial antibodies in children with celiac disease: a specific serological marker of small intestine villous atrophy caused by gluten intolerance. Orvosi Hetilap 132(17): 929-931, 1991

Screening for celiac disease in Down's syndrome patients revealed cases of subtotal villous atrophy without typical for celiac disease HLA-DQ and tissue transglutaminase antibodies. World Journal of Gastroenterology 12(9): 1430-1434, 2006

M2054 Correlation of Histological Villous Atrophy with Tissue Transglutaminase Antibody Level in Patients with Diagnosis of Celiac Disease: Retrospective Analysis of a Cohort of 187 Celiac Patients. Gastroenterology 136(5): A-475-A-476, 2009

ELISA of anti-endomysial antibodies in the diagnosis of celiac disease: comparison with immunofluorescence assay of anti-endomysial antibodies and tissue transglutaminase antibodies. Israel Medical Association Journal 4(8): 594-596, 2002

Anti endomysial antibodies ema predict the intestinal villous atrophy in celiac children study of iga subclass. Clinical and Experimental Allergy 20(Suppl. 1): 52, 1990

Antibodies to human recombinant tissue transglutaminase may detect coeliac disease patients undiagnosed by endomysial antibodies. Alimentary Pharmacology and Therapeutics 17(11): 1415-1423, 1st June, 2003

Celiac disease: anti-endomysial antibody versus villous atrophy. Indian Journal of Gastroenterology 25(6): 317-318, 2006

Natural antibiotic expression in celiac disease - correlation with villous atrophy and response to a gluten-free diet. Digestive Diseases and Sciences 50(4): 791-795, 2005

Positive tissue transglutaminase antibodies with negative endomysial antibodies: low rate of celiac disease. Israel Medical Association Journal 6(1): 9-12, 2004

Transglutaminase IgA antibodies in a celiac disease mass screening and the role of HLA-DQ genotyping and endomysial antibodies in sequential testing. Journal of Pediatric Gastroenterology and Nutrition 57(4): 472-476, 2013

IgA endomysial antibodies in the diagnosis of celiac disease Meta-analysis and cost-effectiveness analysis. Gastroenterology 112(4 Suppl. ): A39, 1997

Lack of usefulness of anti-transglutaminase antibodies in assessing histologic recovery after gluten-free diet in celiac disease. Journal of Clinical Gastroenterology 37(5): 387-391, 2003

Anti-transglutaminase and anti-gliadin antibodies are equally good indicators of mucosal atrophy during gluten challenge in celiac disease. Gastroenterology 118(4 Suppl 2 Part 2): AGA A1136, 2000

M2029 The Dgp/tTg Screen Assay Can Detect Celiac Disease Among Anti-Tissue Transglutaminase Seronegative Gluten-Dependent Patients. Gastroenterology 136(5): A-470, 2009

Extraction and processing of videocapsule data to detect and measure the presence of villous atrophy in celiac disease patients. Computers in Biology and Medicine 78: 97-106, 2016