IgA antiendomysium antibodies have a high positive predictive value for celiac disease in asymptomatic patients

Many attempts have been made to find screening tests for celiac disease to reduce the need for biopsy, or to achieve better selection criteria before intestinal biopsy. We have recently analyzed apparently healthy blood donors for antigliadin antibodies (AGA) to select subjects for further gastrointestinal investigation. A prevalence of gluten enteropathy of at least 1/256 was found in this population. The positive predictive value (+PV), however, was only 20%. In the present study we have analyzed IgA antiendomysium antibodies (IgA-EmA) to estimate the sensitivity and specificity of the test, and determine whether or not the +PV of the assay increases when screening for adult celiac disease in an asymptomatic population. We found that asymptomatic persons with celiac disease may have IgA-EmA. We found a 100% specificity of IgA-EmA in the tested population of blood donors, whereas the sensitivity was about the same as that of IgA-AGA. This result of a +PV of 100% indicates that a positive IgA-EmA could replace biopsy in diagnosing celiac disease. However, further extended studies are needed to determine whether this is applicable in other populations. To screen patients for celiac disease, we recommend the easy and cheap IgA-AGA assay as a preliminary test and the IgA-EmA to verify the diagnosis and avoid unnecessary biopsies.