Serology of coeliac disease: early diagnosis and therapeutic impact

Sera from 88 patients with untreated coeliac disease (54 children and 34 adults), 127 disease controls and 69 healthy controls were tested for anti-gliadin IgA and IgG and anti-endomysium IgA in order to determine the best serological test or the best combination of tests to pick up all the coeliac patients. Only a combination of anti-gliadin IgG and of anti-endomysium IgA affords a 100% sensitivity for coeliac disease. If anti-gliadin IgA was added to the tests, the specificity of the combination gets higher in case of positive anti-gliadin IgA. It appears therefore that it is possible to detect the atypical cases of coeliac disease by a serological screening. This is of major interest in order to begin early dietary treatment of these patients to avoid the development of malignant disorders. The final diagnosis of coeliac disease must however always rely on the results of a small intestinal biopsy.