SCREENING FOR ASYMPTOMATIC CELIAC SPRUE IN FAMILIES

We evaluated the reliability of IgA and IgG antigliadin anti bodies (A GA-A, AGA-G), antireticulin antibody (ARA), endomysial antibodies (EmA ), and alpha(1)-antitrypsin clearance (alpha(1)-AT CL) in the detectio n of celiac sprue (CS) in 59 first-degree asymptomatic relatives of ce liac patients who had duodenal biopsy. Twenty-four relatives who had n ormal results of screening tests were selected at random for biopsy; 3 5 relatives with at least one abnormal test result were biopsied. Elev en relatives were noted to have villous atrophy at biopsy; the diagnos is of celiac sprue was confirmed by histological improvement after glu ten-free diet in six. AGA-G, alpha(1)-AT CL, and EmA had sensitivities of 73%, 73%, and 64%, respectively, with very high levels of specific ity. Sensitivity was improved by the combination of two serological ma rkers (AGA-G + alpha(1)-AT CL = 91%; AGA-G + EmA = 82%; EmA + ARA = 82 %). Furthermore, combination of EmA and ARA has shown the best specifi city and positive predictive value. AGA-G, alpha(1)-AT CL, and EmA are reliable individual markers for the detection of asymptomatic celiac sprue. However, a combination of two of them, including ARA, was more sensitive than the individual tests.