THE DIAGNOSTIC-VALUE OF THE GLIADIN ANTIBODY-TEST IN CELIAC-DISEASE IN CHILDREN - A PROSPECTIVE-STUDY

Serum gliadin antibodies (IgA/IgG) were determined in 191 consecutive children (median age, 2.75 years; range, 0.33-15.5 years) admitted for a small-intestinal biopsy on suspicion of celiac disease. The test wa s a diffusion-in-gel enzyme-linked immunosorbent assay (DIG-ELISA). Of these 191, 14 (7.3%) appeared to have untreated celiac disease. Depen ding on the choice of cut-off value of the test (combined determinatio n of IgA and IgG), the sensitivity was 86-100%, the specificity was 97 -99%, and the positive/negative predictive values were 70-92% and 99-1 00%, respectively. No variation according to age was found. Gliadin an tibodies were determined in 47 children who had well-treated celiac di sease. Fourteen of these children were also investigated when challeng ed with gluten. Gliadin antibodies (IgA or IgG) decreased significantl y in 13 of 13 cases when the patients shifted from a gluten-containing diet to a gluten-free one. During the gluten challenge, the IgG and I gA increased in 14 of 14 and 11 of 14 cases, respectively (two patient s suffered from IgA deficiency). In eight patients who later appeared to be free of celiac disease, the gliadin antibodies were determined o n gluten-free diet and during gluten challenge; no significant differe nces in gliadin antibodies were found. We conclude that this test is u seful in selecting patients with symptoms suggesting celiac disease fo r a small-intestinal biopsy. The test seems to be of some value in mon itoring the effects of a gluten-free diet and during gluten challenge.