DO DIETARY ANTIBODIES STILL PLAY A ROLE IN THE DIAGNOSIS AND FOLLOW-UP OF CELIAC-DISEASE - A COMPARISON AMONG DIFFERENT SEROLOGICAL TESTS

Objective. Comparison between the usefulness of immunological markers and intestinal biopsy in the diagnosis and follow-up of coeliac diseas e. Materials and methods. Serum antibodies to gliadin, several dietary proteins and endomysium were appraised in 27 patients with biopsy pro ven coeliac disease, both while untreated and 6-8 months after gluten withdrawal, when an intestinal biopsy was repeated. Forty-six healthy volunteers entered the study as controls. Antibodies to gliadin and di etary proteins were assessed by ELISA, antibodies to endomysium by ind irect immunofluorescence using monkey oesophagus as antigen. Results. Mean antibody levels to dietary proteins were significantly higher in untreated patients as compared to controls. Their titers decreased aft er gluten withdrawal, but a significant difference was found, except f or casein, for the IgA class only. However, because of their unlinear and unpredictable behaviour, they showed a poor reliability. Antigliad in antibodies showed higher diagnostic accuracy, although they also pr oduced false-positive and false-negative results. Anti-endomysium anti bodies, albeit the more expensive, proved the more reliable, due to th eir 100% specificity. Conclusion. To date, anti-endomysium antibodies are the most reliable marker for coeliac disease: a positivity warrant s an intestinal biopsy. The actual role of antibodies to gliadin, chea per than endomysium, is during follow-up when many determinations are needed. Antibodies to dietary proteins, useful in the pre-endomysium e ra, only have a historical role.