RELIABILITY OF IMMUNOLOGICAL MARKERS OF CELIAC SPRUE IN THE ASSESSMENT OF MUCOSAL RECOVERY AFTER GLUTEN WITHDRAWAL

We studied 47 adults (21 men, 26 women), with biopsy-proven celiac spr ue and anti-endomysin antibody (EmA) positivity while untreated, to ev aluate the usefulness of both serologic markers of celiac sprue [i.e., immunoglobulin A (IgA)-EmA and total Ig-anti-gliadin (AGA) antibodies ] and of a detailed dietary inquiry in predicting the mucosal pattern after gluten withdrawal. A second biopsy was repeated 8-30 months afte r beginning a gluten-free diet, along with EmA and AGA determinations and the dietary inquiry. Both EmA and AGA were appraised by indirect i mmunofluorescence on monkey esophagus and rat kidney, respectively. In testinal biopsy was graded according to Cooke's criteria. After gluten withdrawal, intestinal mucosa reverted to normal in only nine patient s. Both EmA and AGA showed high positive but low negative predictive v alues on intestinal histologic outcome. The positive predictive value of admission of dietary lapses was 100%, whereas the negative predicti ve value was 39.1%. Neither serologic markers nor dietary inquiries ar e to be regarded as reliable predictors of intestinal outcome after a gluten-free diet. Biopsy remains the best means of ascertaining mucosa l recovery.