Serological assays are very helpful in the diagnosis of celiac disease.
Moderate increases in anti-tissue transglutaminase antibodies may be found in other medical disorders, besides celiac disease.
Increased numbers of intra-epithelial lymphocytes are found not only in celiac disease but also in other medical conditions.
Reliable evidence that a patient has celiac disease can only be based on the presence of anti-endomysial antibodies.
Evidence of celiac disease can also be based on the demonstration that the histological lesion is gluten sensitive.
Dr Conleth Feighery and colleagues reviewed the evidence of the sensitivity of antibody tests for celiac disease.
| The endomysial antibody test was negative in 86%|
|European Journal of Gastroenterology & Hepatology|
The researchers reported that serological screening tests for celiac disease have significantly advanced the diagnosis of this condition.
The team noted that very high specificity of anti-endomysial antibody detection has been repeatedly confirmed.
However, the researchers found lower specificity with anti-tissue transglutaminase antibody assays.
The anti-endomysial antibody test has a specificity of almost 100%, whereas the specificity of the anti-tissue transglutaminase antibody test is lower, circa 95%.
The researchers identified 1 study where the participants had raised anti-tissue transglutaminase antibodies.
However, in this study, the endomysial antibody test was negative in 86%.
The study also reported a minimum prevalence of 1:104 of gluten sensitivity in the general population of Iran.
Dr Feighery's team concludes, “Many of these participants were found to have raised intra-epithelial lymphocytes in their small intestinal mucosa.”
“There is currently insufficient evidence to confidently diagnose gluten-sensitive disease in these patients.”
“Hence, the report that a minimum prevalence of 1:104 of gluten sensitivity is found in the general population of Iran is likely to be an over-estimate and requires confirmation.”