Sugar tests detect celiac disease among first-degree relatives

Citation
E. Smecuol et al., Sugar tests detect celiac disease among first-degree relatives, AM J GASTRO, 94(12), 1999, pp. 3547-3552
Citations number
32
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
AMERICAN JOURNAL OF GASTROENTEROLOGY
ISSN journal
00029270 → ACNP
Volume
94
Issue
12
Year of publication
1999
Pages
3547 - 3552
Database
ISI
SICI code
0002-9270(199912)94:12<3547:STDCDA>2.0.ZU;2-S
Abstract
OBJECTIVES: First-degree relatives of patients with celiac disease are at h igh risk for developing the disease themselves. Detection of serum antibodi es and intestinal permeability tests have been useful to identify candidate s for intestinal biopsies. Recently it was demonstrated that abnormal sucro se permeability is a very sensitive marker of active disease. Our objective s in this prospective study were (1) to assess the screening value of perme ability tests, and (2) to compare the usefulness of these markers with that of the celiac disease-related serology in screening for celiac disease in a cohort of first-degree relatives of well-known patients. METHODS: We performed sugar tests in 66 first-degree relatives of probands. Subjects ingested 450 ml of a solution containing sucrose (100 g), lactulo se (5 g), and mannitol (2 g). Subsequently, a complete overnight urine coll ection was obtained. Measurement of sugars was performed by highperformance liquid chromatography. All relatives were evaluated for antigliadin (type IgA and IgG) and endomysial antibodies and subjects positive for any test u nderwent intestinal biopsy. RESULTS: Twelve relatives were diagnosed as having small intestinal mucosal atrophy. Increased sucrose permeability was detected in 9 (75%) of these p atients. Four false-positive determinations were found but all had gastric erosions, which is known to increase sucrose permeability independently of duodenal damage. Increased lactulose/mannitol ratios were observed in all n ew celiac patients. An additional nine relatives had positive results; howe ver, four of them did not accept intestinal biopsy and the remaining five d id not seem to have histological evidence of disease. Endomysial antibodies were detected in 11 of 12 patients and no false-positive cases were observ ed. Antigliadin antibodies were 75% sensitive and 88% specific. CONCLUSIONS: Our study demonstrated that screening using the endomysial ant ibody test is highly sensitive and specific for detecting celiac disease; h owever, almost 10% can be missed. The addition of lactulose/mannitol permea bility testing to the screening protocol allowed us to detect all relatives who actually presented with evidence of gluten sensitivity. Sucrose permea bility exhibited a lower sensitivity; however, it did detect other endoscop ically visible lesions. (Am J Gastroenterol 1999;94:3547-3552. (C) 1999 by Am. Coll. of Gastroenterology).