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Serological testing for celiac disease in adults
Astrid Collatz Schyum1, Jüri Johannes Rumessen1
1Gentofte Hospital HR-Research Unit and Department of Gastroenterology F, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Background And Aim:
We present a systematic review on the performance of currently available methods for serological diagnosis of celiac disease (CD) and the role of human leukocyte antigen (HLA) typing.
Objective:
A literature survey was conducted using PubMed, MeSH database, Web of Science as well as manual searches.
Results:
Tissue transglutaminase antibodies (tTG) (IgA) (tested in nine studies) show sensitivities and specificities in the range of 0.76-0.968 and 0.909-0.98, and deamidated gliadin peptide (DGP) (IgA and IgG) (tested in eight studies) show sensitivities and specificities in the range of 0.69-0.984 and 0.903-1. Endomysial antibodies (EMA) (tested in five studies) show sensitivities and specificities in the range of 0.61-0.937 and 0.98-1, respectively. Combination assays (tested in three studies) using DGP + tTG and DGP (IgA + IgG) show sensitivities and specificities in the range of 0.87-1 and 0.8-1, respectively. HLA DQ2/DQ8 may be necessary for the development of CD-HLA DQ2 in particular. A possible close correlation may also exist between CD and HLA-G.
Conclusion:
DGP and tTG for serological testing for CD show equivalent diagnostic performance. More studies with, in particular, DGP alone and in combination with tTG are necessary before a firm recommendation can be made. HLA typing to exclude CD may still be controversial. It still seems premature to diagnose celiac disease in adults based on serology alone.
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