PREDICTIVE VALUE FOR CELIAC-DISEASE OF ANTIBODIES TO GLIADIN, ENDOMYSIUM, AND JEJUNUM IN PATIENTS ATTENDING FOR JEJUNAL BIOPSY

Objective - To investigate the extent to which the detection of antibodies to gliadin, endomysium, and jejunum predicts the eventual diagnosis of coeliac disease according to the revised ESPGAN diagnostic criteria in a group of patients in whom there is a high suspicion of coeliac disease. Design - Clinical assessment and laboratory analysis of patients with suspected coeliac disease. Setting - Gastroenterology department of teaching hospital. Patients - 96 adults with suspected coeliac disease attending for jejunal biopsy. Main outcome measures - Diagnosis of coeliac disease with the revised criteria of the European Society of Paediatric Gastroenterology and Nutrition in patients with and without antibodies associated with coeliac disease. Results - 28 patients had a clinical diagnosis of coeliac disease, seven of other gastrointestinal diseases, and 12 of miscellaneous diseases; 49 had no diagnosis. Gliadin IgA detected by ELISA was found in all patients with coeliac disease and none of those without, giving a sensitivity, specificity, positive and negative predictive values, and predictive efficiency of 100% for diagnosing coeliac disease within the group. Endomysial IgA was found in 25 (89%) patients with coeliac disease and jejunal IgA in 21 (75%); neither IgA was found in patients without coeliac disease. Conclusion - Detection of gliadin IgA by ELISA and to a lesser extent the endomysial IgA should allow better selection of patients for jejunal biopsy and thus make diagnosing coeliac disease simpler and more efficient.