IGA ANTIENDOMYSIUM ANTIBODIES HAVE A HIGH POSITIVE PREDICTIVE VALUE FOR CELIAC-DISEASE IN ASYMPTOMATIC PATIENTS

Many attempts have been made to find screening tests for celiac diseas e to reduce the need for biopsy, or to achieve better selection criter ia before intestinal biopsy. We have recently analyzed apparently heal thy blood donors for antigliadin antibodies (AGA) to select subjects f or further gastrointestinal investigation. A prevalence of gluten ente ropathy of at least 1/256 was found in this population. The positive p redictive value(+ PV), however, was only 20%. In the present study we have analyzed IgA antiendomysium antibodies (IgA-EmA) to estimate the sensitivity and specificity of the test, and determine whether or not the + PV of the assay increases when screening for adult celiac diseas e in an asymptomatic population. We found that asymptomatic persons wi th celiac disease may have IgA-EmA. We found a 100% specificity of IgA -EmA in the tested population of blood donors, whereas the sensitivity was about the same as that of IgA-AGA. This result of a + PV of 100% indicates that a positive IgA-EmA could replace biopsy in diagnosing c eliac disease. However, further extended studies are needed to determi ne whether this is applicable in other populations. To screen patients for celiac disease, we recommend the easy and cheap IgA-AGA assay as a preliminary test and the IgA-EmA to verify the diagnosis and avoid u nnecessary biopsies.