Atypical coeliac disease found with serologic screening.

Area of Science:

• Immunology
• Gastroenterology
• Clinical Medicine

Background:

• Coeliac disease diagnosis can be challenging due to mild or atypical symptoms.
• Autoantibodies, including reticulin and gliadin antibodies, are established markers for coeliac disease.
• Screening for coeliac disease is often performed in patients with associated conditions.

Purpose of the Study:

• To evaluate the utility of screening for reticulin antibodies in identifying coeliac disease.
• To assess the specificity of IgA class reticulin antibodies for coeliac disease.
• To correlate antibody titres with clinical presentation and response to a gluten-free diet.

Main Methods:

• Screening of unselected sera for reticulin antibodies during requests for other tissue antibody determinations.
• Testing for IgA class reticulin antibodies and serum gliadin antibodies.
• Monitoring of jejunal mucosal histology and antibody titres in response to a gluten-free diet.

Main Results:

• Eighteen patients with coeliac disease were identified through reticulin antibody screening.
• IgA class reticulin antibody demonstrated high specificity for coeliac disease.
• Most patients had positive serum gliadin antibodies; abdominal symptoms were infrequent.
• Gluten-free diet improved jejunal histology and decreased antibody titres.

Conclusions:

• Reticulin antibody screening is an appropriate method for detecting coeliac disease, especially in patients with mild or atypical symptoms.
• IgA class reticulin antibody is a specific serological marker for coeliac disease.
• Decreased antibody titres and improved histology confirm the efficacy of a gluten-free diet.