Endomysial antibodies predict celiac disease irrespective of the titers or clinical presentation

AIM:To investigate the association between serum antibody levels and a subsequent celiac disease diag-nosis in a large series of children and adults. METHODS:Besides subjects with classical gastrointestinal presentation of celiac disease,the study cohort included a substantial number of individuals with extraintestinal symptoms and those found by screening in at-risk groups.Altogether 405 patients underwent clinical,serological and histological evaluations.After collection of data,the antibody values were further graded as low[endomysial(EmA)1:5-200,transglutaminase 2 antibodies(TG2-ab)5.0-30.0 U/L]and high (EmA 1:≥500,TG2-ab≥30.0 U/L),and the serological results were compared with the small intestinal mucosal histology and clinical presentation. RESULTS:In total,79%of the subjects with low and 94%of those with high serum EmA titers showed small-bowel mucosal villous atrophy.Furthermore, 96%of the 47 EmA positive subjects who had normal mucosal villi and remained on follow-up either subsequently developed mucosal atrophy while on a glutencontaining diet,or responded positively to a glutenfree diet. CONCLUSION:Irrespective of the initial serum titers or clinical presentation,EmA positivity as such is a very strong predictor of a subsequent celiac disease diagnosis.

Antibodies in celiac disease:implications beyond diagnostics

Celiac disease is a multisystemic dietary,gluten-induced autoimmune disorder characterized by the presence of transglutaminase(TG)2 serum autoantibodies.Distinct autoantibodies targeting members of the TG family(TG2,TG3 and TG6)are found deposited in small-bowel mucosa and in extraintestinal tissues affected by the disease.Serum autoantibodies against other self-antigens also emerge in untreated celiac disease patients.Although villous atrophy and crypt hyperplasia in small-bowel biopsy samples are still the gold standards in diagnostics,celiac disease-specific antibodies are widely used as diagnostic aids.Gluten-induced small-bowel mucosal T-cell response is the cornerstone in the pathogenesis of the disorder,but humoral immunity may also play a central role.This review article is focused on the autoantibodies that occur in the context of celiac disease.The article summarizes the diagnostic utility of different celiac-related antibodies and discusses their roles in the pathogenesis of the disease.