Sorbitol H-2-breath test versus anti-endomysium antibodies for the diagnosis of subclinical/silent coeliac disease

Recent studies have shown that the prevalence of anti-endomysial antibodies (EMAs) in clinical practice is lower than expected; the aim of our study w as therefore to compare the sorbitol H,breath test (BT) with EMAs in the di agnosis of subclinical/silent coeliac disease and to compare with histologi c lesions. Methods: We studied 123 consecutive patients with subclinical (9 6) and silent (27) coeliac disease. Expiratory samples were collected befor e the patients drank the test solution (5 g of sorbitol in 150 ml of tap wa ter) and every 30 min for 4 h. An increase in H-2 concentration of at least 20 ppm over fasting baseline was considered positive for sorbitol malabsor ption. EMAs were screened by the indirect immunofluorescence method. Result s: EMAs were positive in 77/96 (80.80%) and sorbitol H-2-BT in 94/96 (97,91 %) patients with subclinical coeliac disease, while EMAs were positive in 1 7/27 (62.96%) and sorbitol H-2-BT in 26/27 (96.29%) patients with silent co eliac disease (P < 0.001 in both forms of coeliac disease). The best cut-of f values in ppm and minutes are higher and shorter in the severe form than in the minor form of intestinal damage, respectively (P < 0.001 in both for ms). Conclusions: This study indicates that almost all subclinical/silent c oeliac patients show abnormal sorbitol H-BT and that there is a strict corr elation between cut-off value (in ppm and minutes) and histologic lesions. In particular, the maximal cut-off value (in ppm and in minutes) correlates statistically with the more severe the grade of intestinal damage. Finally . the prevalence of EMA in subclinical/silent disease is lower than expecte d.