SERUM IGA ANTIENDOMYSIUM ANTIBODY-TITERS AS A MARKER OF INTESTINAL INVOLVEMENT AND DIET COMPLIANCE IN ADULT CELIAC SPRUE

IgA-class antiendomysium antibodies (IgA-EmAs) are a very sensitive an d specific serological marker of celiac sprue. Using an indirect immun ofluorescent method, we evaluated the kinetics of the antibody titers both during a gluten-free diet and after gluten was added, comparing t hem with the intestinal histological pattern. The IgA-EmA titers were evaluated on sera from 91 untreated adults with biopsy-proven celiac s prue and, when positive, were reappraised after different durations of gluten-free diet. Antibody titers were also retested in eight adolesc ents who had voluntarily discontinued the diet while they were on a fr ee diet. The IgA-EmAs were detectable in 85 of 91 (93.40%) patients bu t in none of the 438 controls (100% specificity). The antibody titers ranged from 1:5 to 1:2,000 or more and the intestinal histopathologica l pattern paralleled the antibody titers. After gluten withdrawal, IgA -EmA titers declined to zero in all patients complying with their diet . Modifications in gut histopathologic condition paralleled IgA-EmA ki netics, although seroconversion to negativity preceded mucosal recover y. After a gluten rechallenge, deterioration in gut histopathologic co ndition followed EmA reversion to positivity. Three negative IgA-EmA t ests did not reflect a worsening in gut histopathologic condition afte r a gluten-containing diet, thus making the diagnosis of celiac sprue uncertain.