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Celiac Disease Serological Tests

Among the serological tests needed to diagnose CD, the measurement of anti-gliadin IgA antibodies (AGA), has completely fallen into disuse and probably justifiably abandoned, as its sensitivity and specificity is very low (around 50%).

In 1997, tTG was established by Dieterich et al to be the auto-antigen for anti-endomysial antibodies[18] and since then, is preferred for clinical use, because it show good sensitivity, greater than 90%, and a high specifi city, around 95%, although it displays small variations between the different commercial kits employed[19].

The presence of these antibodies correlates with the degree of villous atrophy and various studies have clearly shown that the sensitivity of testing tTG is decreased in patients with normal duodenal biopsies or with mild histological changes[20]. Measurement of tTG antibodies of the IgA isotype is usually determined in the clinical practice. Nevertheless, IgA deficiency occurs in 1.7%-2.6% of celiac disease patients, which represents 10-15 times increase, over that in the general population.

If IgA deficiency is found, measuring the IgG class tTG is recommended[21]. Diagnosis of celiac disease based solely on serologic markers is not accepted and the identification of the characteristics changes at the duodenal mucosa is required before starting on a GFD.

In conclusion, in clinical practice, serologic tests for celiac disease are frequently used to identify both symptomatic and asymptomatic at-risk individuals who require an intestinal biopsy examination to confi rm the diagnosis.

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