Adult endomysial antibody-negative coeliac disease and cigarette smoking

Objective To determine the relative incidence and characteristics of endomy sial antibody (EMA)-negative coeliac disease in adults. Design Retrospective analysis of prospectively collected data on adults wit h newly diagnosed coeliac disease, with determination of EMA status before gluten withdrawal. Setting District general hospital (secondary care institution). Participant s Sixty consecutive incident cases. Main outcome measures (i) Proportion of cases who were EMA-negative; (ii) c omparison of clinical and laboratory variables at diagnosis for EMA-positiv e and EMA-negative subjects. Results Fifteen subjects (25%, 95% CI 15-38%) were EMA negative, of whom on ly two were IgA deficient. There was clinical evidence in all 15 patients a nd histological evidence in 13 patients of a response to gluten withdrawal, No significant differences were found between EMA-positive and EMA-negativ e subjects with respect to histological features, age, gender, clinical man ifestations, concurrent autoimmune disorders, family history of coeliac dis ease, or haemoglobin and albumin concentrations at diagnosis. However, EMA- negative status at diagnosis was associated strongly with current or recent cigarette smoking (OR 7.0, 95% CI 1.7-31.5, P= 0.003). Conclusions A substantial minority of patients with otherwise typical coeli ac disease are EMA negative, and most of these are IgA replete. The value o f EMA as a screening tool is therefore limited. EMA status in untreated coe liac disease correlates strongly with cigarette smoking history: this may b e of pathogenic significance, given the previously demonstrated association between smoking and the risk of coeliac disease, Eur J Gastroenterol Hepat ol 13:667-671 (C) 2001 Lippincott Williams & Wilkins.