Antiendomysial antibody test reliability in children with frequent diarrhea and malnutrition: Is it celiac disease?

Background: The aim of this study was to evaluate the specificity of the im munoglobulin A (IgA) antiendomysial antibody test in the diagnosis of celia c disease in a group of malnourished children with acute diarrhea, chronic diarrhea, or parasitosis, because the reliability of this test has been que stioned when applied to this specific group of patients. Methods: Serum IgA level, IgA antiendomysial antibody (EMA) test, and stool examination were performed in 315 children, ranging in age 6 months to 13 years (range, 41 +/- 2.9 months), affected by malnutrition, isolated or in association with diarrhea or parasitosis. Independent of results, 33 childr en with a strong suspicion of celiac disease, also underwent IgA antitransg lutaminase antibody test and jejunal biopsy. Results: The EMA test was negative in 313 children, including the 43 with p arasitosis, being positive in two patients in whom biopsy disclosed typical celiac mucosal abnormalities (1:157). The 31 children with negative EMA te st who underwent biopsy also showed negative antitransglutaminase antibody results. Their biopsies disclosed normal mucosa in 1 patient, variable degr ee of jejunal atrophy (grade 1 and 2) in 27 patients, and grade 3 abnormali ties in 3 patients. One of these three children, showing severe jejunal atr ophy, died. The diagnosis of celiac disease was apparently not confirmed by a protracted gluten challenge in the other two children. Conclusions: The specificity of the EMA test seems to be high also in child ren with chronic malnutrition and diarrhea. However, the possibility of fal se-negative tests among immunologically compromised children cannot be excl uded. In doubtful cases, the gluten challenge is required in malnourished c hildren with clinical picture, biopsy finding, and evolution suggestive of celiac disease.