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Another study concludes that the human anti-tTG screening test may be
superior to the EmA test:

Paste this link together on one line:
http://www.blackwell-synergy.com/links/doi/10.1046/j.1365-
2036.2003.01595.x/abs/

Aliment Pharmacol Ther. 2003 Jun 1;17(11):1415-23.

Antibodies to human recombinant tissue transglutaminase may detect coeliac
disease patients undiagnosed by endomysial antibodies.

Tesei N, Sugai E, Vazquez H, Smecuol E, Niveloni S, Mazure R, Moreno ML,
Gomez JC, Maurino E, Bai JC.

'Dr Carlos Bonorino Udaondo' Gastroenterology Hospital, Del Salvador
University, Buenos Aires, Argentina; USNMA, San Martin Hospital, La Plata,
Argentina.

BACKGROUND:
The screening and diagnosis of coeliac disease have been simplified by the
advent of new serological tools.

AIM:
To assess the clinical utility of a newly developed kit for antibodies to
human recombinant tissue transglutaminase (hu-anti-tTG) in a large
population of patients undergoing intestinal biopsy for suspected
intestinal disorders.

METHODS:
We evaluated 426 serum samples from consecutive adult patients (250 from
untreated coeliac disease patients and 176 from individuals in whom a
diagnosis of coeliac disease had been excluded), obtained at the time of
intestinal biopsy. Samples were tested for immunoglobulin A (IgA) hu-anti-
tTG by enzyme-linked immunoabsorbent assay, IgA endomysial antibodies (EmA)
by indirect immunofluorescence and IgA and IgG antigliadin antibodies by
enzyme-linked immunoabsorbent assay. A sub-group of samples was also
assessed for a guinea-pig-based anti-tissue transglutaminase.

RESULTS:
According to the cut-off for hu-anti-tTG, the sensitivity, specificity and
positive and negative predictive values were 91%, 96%, 97% and 87%,
respectively. Simultaneous determination of EmA showed values of 86%, 100%,
100% and 83% for the same parameters. Although 19 coeliac disease patients
(7.6%) were negative for EmA and hu-anti-tTG, both tests rendered superior
statistical values to antigliadin antibody tests. At diagnosis, IgA
deficiency was detected in 11 patients, but both assays were able to detect
samples with mild to moderate deficiency. The comparison of hu-anti-tTG
with EmA showed excellent concordance between the tests (kappa statistic,
0.85). Discordance was observed in 20 samples from coeliac disease patients
(8%) and in nine samples from controls (5%). Fifteen samples had an EmA-
negative but hu-anti-tTG-positive serology, and five showed the converse
pattern. Comparison of human recombinant and guinea-pig tests showed
concordant results in 96% of cases.

CONCLUSIONS:
The quantitative determination of hu-anti-tTG type IgA using a commercial
enzyme-linked immunoabsorbent assay kit was highly sensitive and specific
for the detection of coeliac disease. Our results in a large population of
patients with a clinical condition suggestive of the disorder demonstrated
that the test can be used to detect a substantial number of patients
otherwise unrecognized by IgA EmA.

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