Positive tissue transglutaminase antibodies with negative endomysial antibodies: coeliac disease or not?

摘要

Coeliac disease (CD) is a chronic autoimmune disorder of the small intestine induced in genetically susceptible individuals by the ingestion of gluten, the major storage protein of wheat, rye and barley. It has been estimated that overall prevalence of CD in the general population is as high as 1/160 or 0.62%. The current diagnostic algorithm for CD includes initial serological screening test, followed by a confirmatory small intestinal biopsy showing the autoimmune insult typical of CD. In following such an approach, serological screening is primarily used to identify those individuals in need of a diagnostic endoscopic biopsy. The most sensitive and specific serological tests for the diagnosis of CD are based on the detection of immunoglobulin A (IgA) antibodies against human tissue transglutaminase (tTGA) enzyme and connective tissue elements covering individual smooth muscle fibres, endomysium antibodies (EMA).