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Sugar tests detect celiac disease among first-degree relatives
E Smecuol1, H Vazquez, E Sugai
1Small Intestinal Section, Clinical Service, Hospital de Gastroenterología, Buenos Aires, Argentina.
The American Journal of Gastroenterology
|December 22, 1999
Summary
Screening first-degree relatives for celiac disease (CD) using endomysial antibodies and lactulose/mannitol permeability tests is effective. This combined approach identifies all individuals with gluten sensitivity, improving early detection of CD.
Area of Science:
- Gastroenterology
- Immunology
- Clinical Diagnostics
Background:
- First-degree relatives of celiac disease (CD) patients have a high risk of developing CD.
- Serum antibodies and intestinal permeability tests aid in identifying individuals for biopsy.
- Abnormal sucrose permeability is a sensitive marker for active CD.
Purpose of the Study:
- To evaluate the screening value of permeability tests for CD in high-risk relatives.
- To compare CD-related serology with permeability markers for CD screening.
- To assess diagnostic utility in a cohort of first-degree relatives.
Main Methods:
- 66 first-degree relatives underwent sugar absorption tests (sucrose, lactulose, mannitol).
- Urine samples were collected for sugar measurement via high-performance liquid chromatography.
- Relatives were tested for antigliadin and endomysial antibodies; positive cases proceeded to biopsy.
Main Results:
- 12 relatives diagnosed with celiac disease; 75% showed increased sucrose permeability.
- Increased lactulose/mannitol ratios observed in all new CD patients.
- Endomysial antibodies detected in 11/12 CD patients; antigliadin antibodies showed 75% sensitivity and 88% specificity.
Conclusions:
- Endomysial antibody testing is highly sensitive and specific for CD, though may miss ~10%.
- Combining lactulose/mannitol permeability tests with serology detects all relatives with gluten sensitivity.
- Sucrose permeability showed lower sensitivity but identified other endoscopic lesions.