High prevalence of silent celiac disease in preschool children screened with IgA/IgG antiendomysium antibodies

Background: Because of the different sensitivity and specificity of serolog ic tests, the search for silent celiac disease is usually performed with th e combined or sequential use of several tests. Among these, the IgA-class e ndomysium antibody test has the highest specificity and positive predictive value, but it may overlook IgA-deficient patients. Methods: To test a new one-step screening approach, serum samples from 427 apparently healthy, 3- to 6-year-old Hungarian children were investigated f or IEA-class and IgG-class endomysium antibodies using monkey esophagus and human jejunum as substrates. Results: Five new cases with flat mucosa were identified by strong endomysi um antibody positivity and subsequent jejunal biopsy, yielding a celiac dis ease prevalence of 1:85. An additional child may have latent celiac disease (slight histologic changes at present). Two of the screening-detected celi ac patients exhibited only IgG-class endomysium antibodies due to associate d IgA-deficiency. Despite the young age of the screened population, antigli adin antibodies were positive in only three of the five celiac patients. Conclusions: Prevalence of celiac disease in the study population was much higher than expected on the basis of antigliadin antibody-based studies. Th e screening system used detected celiac cases in which there was IgA-defici ency and those in which there was not and also those negative for antigliad in antibodies. The findings suggest the importance of the primary testing o f autoantibodies in future celiac disease screening policies.