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Seeking medical or informed lay opinion on the following abstract on
seronegative coeliac testing--specifically the following sentence:

"Our study suggests that negative predictive value of serology should be
interpreted cautiously since coeliacs with partial VA are negative in
serology."

How should this abstact be interpreted?

Entire abstract reads: (citation at end of abstract)

The aim of this study was to assess the correlation of sugar absorption
test (SAT) using Lactulose/Mannitol/Sucrose (LMS), with IgA-endomysium
(EMA), and IgA-gliadin (AGA) antibodies in relation to the severity of
the intestinal mucosal damage in adult coeliacs.  We have differentiated
the Marsh classification in partial villous atrophy (VA) (III a),
subtotal VA (III b), and total VA (III c).  Twenty-nine untreated adults
coeliacs, with a mean age of 47 years, range 20-76 yrs were studied over
3 years.  SAT, IgA-AGA and IgA EMA were performed in 29 consecutive
coeliac patients with villous atrophy on a gluten containing diets.
RESULTS:  Histopathological evaluation of small intestinal mucosa showed
a partial VA in 14/29, subtotal VA in 10/29 and total VA in 5/29.  All
coeliacs with total VA had positive EMA (5/5 100%).  However in coeliacs
with partial VA sensitivity of EMA was poor (4/14 29%).  Sensitivity of
EMA in patients with subtotal VA was 50% (5/10).  AGA was raised in 3/14
(21%), 6/10 (60%), and in 4/5 (80%) coeliacs with partial, subtotal and
total VA respectively.  AGA was raised in 13/29 (sensitivity 45%).  SAT
was abnormal in 26/29 (sensitivity:  89%).  One patient had abnormal
SAT, EMA and AGA.  Eleven of 29 patients (38%) were negative for AGA and
EMA, but SAT was abnormal in 10 of them.  One patient was positive for
EMA, negative for AGA, normal for SAT.  EMA and/or AGA were positive in
18/29 (sensitivity 62%).  Our study suggests that negative predictive
value of serology should be interpreted cautiously since coeliacs with
partial VA are negative in serology.  Over the last ten years SAT and
EMA have been accepted as screening tools for CD.  SAT seems to be more
sensitive than serology.  However there is no standardized agreement in
the literature for serology and SAT.  A combination of SAT and serology
may provide a good sensitivity in order to detect that subgroup of
coeliacs with milder histopathological abnormality.

Rostami K, Kerckhaert J, von Blomberg BM, Meijer JW, Wahab P, Mulder CJ,

Neth J Med 1998 Jul;53(1):15-9


--
Sally Lopez
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