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Value and Use of Serologic Markers of Celiac Disease

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Advances in Celiac Disease

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Abstract

High efficient serological markers (SM) for celiac disease (CD) have evolved since the eighties thus completely modifying the approach to CD diagnosis. These celiac SM, i.e. tissue Transglutaminase (TG2), endomysial (EMA) and deamidated gliadin peptides (DGP) show different performance. Both IgA class TG2 (TGA-IgA) and EMA (EMA-IgA) display the highest accuracy. For EMA-IgA sensitivity in adults is slightly above 86% and the specificity close to 100%. In paediatric patients, sensitivity is ≥90%, and pooled specificity 98.2%. For TGA-IgA in the adult population sensitivity is above 95% and specificity in the range of 90%–96%, while in children sensitivity is around 90% and specificity around 95%. Measuring DGP antibodies, either IgA or IgG (DGPA-IgG/IgA) has a lower efficiency for CD diagnosis as compared to TGA and EMA, for all age groups. Contrary to other SM, DGPA-IgG perform better than IgA class tests. Only in IgA deficient individuals is an IgG based test indicated, preferably TGA-IgG or DGPA-IgG. If CD is suspected, measurement of total serum IgA and TGA-IgA is superior to other combinations and should be the initial step for initial testing at any age, while DGPA tests are not recommended because of their lower efficiency. In children and adolescents, due to their high accuracy, in absence of positive TGA/EMA CD diagnosis is unlikely, while in adults if the suspicion of CD is high, intestinal biopsy should be pursued even if SM are negative. Conversely children and adolescents with positive serology should be referred to a paediatric gastroenterologist to establish a firm diagnosis. On account of the high specificity of CD SM, patients with positive CD autoimmunity (TGA-IgA/EMA-IgA) but with mild histological changes (Marsh 0/I) should be followed carefully because of the risk of developing CD in the future.

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Abbreviations

AGA:

Antigliadin antibodies

ARA:

Antireticulin antibodies

TGA-IgA:

IgA antibodies against type-2 (tissue) transglutaminase

TGA-IgG:

IgG antibodies against type-2 (tissue) transglutaminase

EMA-IgA:

IgA endomysial antibodies

DGP:

Deamidated gliadin peptides

ELISA:

Enzyme Immuno assay

IF:

Immunofluorescence

DGPA-IgG:

IgG Deamidated gliadin peptides antibodies

DGPA-IgA:

IgA Deamidated gliadin peptides antibodies

SM:

Serological marker

SBB:

Small bowel biopsy

TG2:

Tissue Transglutaminase

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Authors and Affiliations

  1. Pediatric Gastroenterology Unit, La Fe University Hospital, Valencia, Spain

    C. Ribes-Koninckx & E. Donat

  2. Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain

    C. Ribes-Koninckx, M. Roca & E. Donat

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  1. C. Ribes-Koninckx
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  2. M. Roca
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  3. E. Donat
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Correspondence to C. Ribes-Koninckx .

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  1. Department of Pediatrics, São João University Hospital, Porto, Portugal

    Jorge Amil-Dias

  2. Department of Pediatrics, Autonoma University , Madrid, Spain

    Isabel Polanco

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Ribes-Koninckx, C., Roca, M., Donat, E. (2022). Value and Use of Serologic Markers of Celiac Disease. In: Amil-Dias, J., Polanco, I. (eds) Advances in Celiac Disease . Springer, Cham. https://doi.org/10.1007/978-3-030-82401-3_6

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  • DOI: https://doi.org/10.1007/978-3-030-82401-3_6

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