COMPARISON OF SERUM ANTIGLIADIN, ANTI-ENDOMYSIUM, AND ANTI-JEJUNUM ANTIBODIES IN ADULT CELIAC SPRUE

We compared the diagnostic accuracy of a new immunological marker of c eliac sprue (CS), the antijejunum antibody (JAB), with that of antigli adin (AGA) and antiendomysium (EmA) antibodies. One hundred untreated adults with biopsy-proven CS, 52 healthy controls, and 57 patients wit h inflammatory bowel disease, lymphoma of the small bowel, Whipple's d isease, and irritable bowel syndrome were investigated. Only JAB and E mA were detected at a similar titer in all patients with untreated CS but in no controls (100% sensitivity and specificity). Sensitivity of AGA was, respectively, 55% for IgA and 78% for Ig class, with a 100 an d 82% specificity. The differences in frequencies between both EmA and JAB with IgA and IgG AGA were highly significant. We conclude that JA B and EmA provide a reliable noninvasive screening test for clinically significant gluten-sensitive enteropathy. The lower cost of IgA-JAB i s a major advantage, owing to the different availability of the lower third of the esophagus and jejunum from primates. The sensitivity and specificity of the two tests are almost identical, but we find interpr eting EmA easier than JAB especially when the titer is low.