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Dear All,

 

First thank you so much to those of you who forwarded my questions to
some of the celiac "gurus".  Its great to have feedback from them!

 

I have listed below an article which addresses my question and pretty
much affirmed my suspicions.  The blood tests are not proving to be
clinically as accurate in day to day utilization as they were when being
studied more in the research setting.  That means that we potentially
can miss a lot of celiacs if all we do is screen for celiac disease with
TTG and anti-endomysial.  So, we all should continue to remain diligent
in our hunt for celiac disease, and listen to our "guts"!  This would
mean biopsying people who we suspect even if lab is negative.  This is
causing me to rethink my approach to my children who have had negative
bloodwork, and therefore have not had EGD.  

 

May all of you have a great weekend!

 

Michelle Eaton, PA-C

GI Specialists

20375 W. 151st Street, Suite 354

Olathe, KS 66061

 

 

 

 

 

 

 

 

 

 

 

Dig Dis Sci. 2004 Apr;49(4):546-50. 

Seronegative celiac disease: increased prevalence with lesser degrees of
villous atrophy.

Abrams JA, Diamond B, Rotterdam H, Green PH.

Department of Medicine, Columbia University College of Physicians and
Surgeons, New York, New York, USA.

 

Our aim was to assess differences in the sensitivities of serologic
tests used for the diagnosis of celiac disease among patients with
varying degrees of villous atrophy. Among 115 adults with biopsy-proven
celiac disease who fulfilled strict criteria, including serologic
testing at the time of diagnosis and response to a gluten-free diet, 71%
had total villous atrophy and 29% partial villous atrophy. Endomysial
antibody was positive in 77% of those with total villous atrophy,
compared to 33% with partial villous atrophy (P < 0.001). There was no
difference in sensitivity when the type of presentation (classical vs.
silent) was compared. Endomysial antibody-positive and negative patients
did not differ with respect to age at diagnosis, duration of symptoms,
mode of presentation, or family history of celiac disease. All
anti-tissue transglutaminase-positive patients had TVA on biopsy.
Seronegative celiac disease occurs. Endomysial antibody positivity
correlates with more severe villous atrophy and not mode of presentation
of celiac disease. Serologic tests, in clinical practice, lack the
sensitivity reported in the literature.

 


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