Changing Patterns of Serological Testing for Celiac Disease in Latvia

Background and Aims. A number of recent guidelines have discouraged the use of the old anti-gliadin tests for the detection of celiac disease; tissue transglutaminase IgA (tTGA) and anti-endomysial (EMA) tests are recommended instead. Our aim was to evaluate how the current recommendations have been applied in real practice. The secondary aim was to evaluate the positivity rates provided by different test types. Methods. We analyzed the number of celiac disease tests [anti-gliadin IgA (AGA), anti-gliadin IgG (AGO), tTGA and EMA] performed by the largest laboratory in Latvia. The analysis was performed on a yearly basis for the period between 2004 and 2009. Additionally, we analyzed the percentage of the positive test results for each of the tests. Results. The number of patients being tested for celiac disease constantly increased, with the average annual growth of 16.1%; this trend was similar both in children and in adults. The majority of patients (62.6%) were tested with anti-gliadin tests only; 27.7% were tested with either tTGA or EMA, while 9.7% were tested by a combination of the above groups. There was a substantial difference in the positivity rates of the different tests from 0.94% for EMA to 21.8% for AGG. Substantial differences were also present between various manufacturers' products. Conclusion. The current guidelines and the published evidence on the proper use of serological tests for celiac disease have been slow to be applied in clinical practice; more intensive education campaigns and change in reimbursement systems could improve the situation. Nevertheless, more clinicians in Latvia are checking patients for celiac disease; this suggests an overall increased awareness.