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The old and new tests for celiac disease: which is the best test combination to diagnose celiac disease in pediatric patients?

  • Ignazio Brusca EMAIL logo , Antonio Carroccio , Elio Tonutti , Danilo Villalta , Renato Tozzoli , Maria Barrale , Filippo M. Sarullo , Pasquale Mansueto , Stella Maria La Chiusa , Giuseppe Iacono und Nicola Bizzaro
Veröffentlicht/Copyright: 26. September 2011
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Clinical Chemistry and Laboratory Medicine
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine Band 50 Heft 1

Abstract

Background: In the diagnosis of celiac disease (CD), serum assays for anti-endomysium (EMA) and anti-transglutaminase (anti-tTG) antibodies have excellent diagnostic accuracy. However, these assays are less sensitive in young pediatric patients. Recently, a new ELISA test using deamidated gliadin peptides (DGP) as antigen has proved to be very sensitive and specific even in pediatric patients. In addition, anti-actin IgA antibodies (AAA) is another test that can be used in CD patients because antibody concentrations correlate with the degree of villous atrophy. This study evaluated the clinical accuracy of anti-tTG, EMA, AGA, anti-DGP and AAA and the effectiveness of these in different combinations for diagnosing CD in a large cohort of pediatric patients.

Methods: Sera of 150 children under 6 years of age were tested: 95 patients had a diagnosis of CD, while 55 patients who did not suffer from CD were used as controls. Anti-DGP IgA/IgG and AAA were assayed with ELISA kits, while anti-tTG IgA/IgG and AGA IgG/IgA were assayed using a quantitative fluoroimmunoassay. The EMA test was conducted by indirect immunofluorescence.

Results: Seventy-six of 95 (80%) CD patients were positive for DGP IgA and/or tTG IgA. Eighty of 95 (84.2%) patients were positive for DGP IgG and/or tTG IgA. None of the controls were positive for these antibodies. Eighty-four of 95 (88.4%) patients and 8/55 (14.5%) controls were positive for AAA and/or anti-tTG IgA.

Conclusions: In very young children, association of anti-tTG IgA with anti-DGP IgG is the best test combination for diagnosing CD, yielding a cumulative sensitivity of 84.2% and a specificity of 100%.

Keywords: actin; celiac disease; children; diagnostic accuracy; endomysium; gliadin; transglutaminase
Corresponding author: Dr. Ignazio Brusca, “Buccheri La Ferla” Hospital, via Messina Marine 197, 90100 Palermo, Italy Phone: +39 091479271, Fax: +39 091479268
Received: 2011-4-4
Accepted: 2011-8-28
Published Online: 2011-09-26
Published in Print: 2012-01-01

©2011 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/cclm.2011.714
Schlagwörter für diesen Artikel
actin; celiac disease; children; diagnostic accuracy; endomysium; gliadin; transglutaminase

Artikel in diesem Heft

  1. Editorial
  2. Targeted therapy for HER-2: personalized medicine for her, too
  3. Review
  4. Circulating levels of HER-2/neu oncoprotein in breast cancer
  5. Mini Review
  6. The human epidermal growth factor receptor 2 (HER2)
  7. Opinion Paper
  8. Proposed criteria for sorting examined properties in clinical laboratory reports
  9. Guidelines and Recommendations
  10. Properties and units in the clinical laboratory sciences, Part XXIII. The NPU terminology, principles and implementation –a user’s guide (Technical Report 2011) (IFCC–IUPAC)
  11. Genetics and Molecular Diagnostics
  12. Establishing high resolution melting analysis: method validation and evaluation for c-RET proto-oncogene mutation screening
  13. Decreased mRNA expression of CCL5 [RANTES] in Alzheimer's disease blood samples
  14. General Clinical Chemistry and Laboratory Medicine
  15. A risk-analysis approach to the evaluation of analytical quality
  16. C-statistics versus logistic regression for assessing the performance of qualitative diagnostic tests
  17. Detection and quantification of M-proteinemia: comparison of various methods for serum protein electrophoresis
  18. External quality assessment of point-of-care International Normalized Ratio (INR) testing in Europe
  19. Comparison of two point-of-care testing (POCT) devices for fetal lactate during labor
  20. Simultaneous quantification of 19 drugs/metabolites in urine important for pain management by liquid chromatography-tandem mass spectrometry
  21. Enzyme-linked immunoassay for plasma-free metanephrines in the biochemical diagnosis of phaeochromocytoma in adults is not ideal
  22. The old and new tests for celiac disease: which is the best test combination to diagnose celiac disease in pediatric patients?
  23. Improving diagnosis of adult-type hypolactasia in patients with abdominal complaints
  24. Synovial and serum levels of uncarboxylated matrix Gla-protein (ucMGP) in patients with arthritis
  25. The diagnostic performance of allergen-molecules in comparison to allergen-extracts
  26. Analytical performances of cystatin C turbidimetric assay: which impact on accuracy of glomerular filtration rate estimation in renal transplantation?
  27. Evaluation of Aution Max AX-4030 and 9UB Uriflet, 10PA Aution Sticks urine dipsticks in the automated urine test strip analysis
  28. Reference Values and Biological Variations
  29. Diurnal variability of total calcium during normal sleep and after an acute shift of sleep
  30. Infections Diseases
  31. Comparison of two immunoassays for determining hepatitis B virus serum markers
  32. Cardiovascular Diseases
  33. Ultra-sensitive troponin I levels to exclude acute myocardial infarction from myocardial injury
  34. Diabetes
  35. Extracellular matrix-associated (GAGs, CTGF), angiogenic (VEGF) and inflammatory factors (MCP-1, CD40, IFN-γ) in type 1 diabetes mellitus nephropathy
  36. Letters to the Editor
  37. Serum HER-2/ECD analysis in monitoring breast cancer patients
  38. No evidence for the involvement of the lipoxin A4 receptor (FPR2/ALX) gene in the susceptibility to coronary artery disease
  39. Does the presence of 3-epi-25OHD3 affect the routine measurement of vitamin D using liquid chromatography tandem mass spectrometry?
  40. Validity of the measurement of capillary cholesterol in the diagnosis of defined hypercholesterolemia
  41. Prelims
  42. Prelims
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