International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: http://www.sciepub.com/journal/ijcd Editor-in-chief: Samasca Gabriel
Open Access
Journal Browser
Go
International Journal of Celiac Disease. 2014, 2(2), 64-66
DOI: 10.12691/ijcd-2-2-8
Open AccessArticle

Serological Diagnosis of Celiac Disease –Moving Beyond the Tip of the Iceberg

Aaron Lerner1,

1Pediatric Gastroenterology and Nutrition Unit, Carmel Medical Center, B, Rappaport School of Medicine, Technion-Israel institute of Technology, Haifa, Israel

Pub. Date: May 23, 2014

Cite this paper:
Aaron Lerner. Serological Diagnosis of Celiac Disease –Moving Beyond the Tip of the Iceberg. International Journal of Celiac Disease. 2014; 2(2):64-66. doi: 10.12691/ijcd-2-2-8

Abstract

The majority of celiac disease affected patients are undiagnosed. Since the epidemiology and phenotype of CD is constantly changing towards latent, hyposymptomatic or asymptomatic behavior and since there is an increased risk of complications, early diagnosis and subsequent adherence to gluten-free diet is highly recommended. Multiple serological tests are on the market and the most frequently used test is IgA-tTG. This is not sensitive enough to be used alone, and combined tests enhance detection. Several combinations have been studied but not accurately compared to each other. The most frequently used combination is anti IgG-DGP with IgA-tTG, however, increasingly the new generation of anti neo-epitope DGP+tTG IgG+IgA is being used. At present, there is insufficient information to demonstrate that screening general populations definitely results in clinical benefit. However, asymptomatic individuals in high-prevalence groups should be screened.

Keywords:
celiac disease diagnosis serology transglutaminase CeliCheck diaminated gliadin peptide

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Lerner A. Factors affecting the clinical presentation and time diagnosis of celiac disease: The Jerusalem and the West Bank-Gaza experience. Isr J Med Sci. 1994; 11: 294-295.
 
[2]  Lerner A, Agmon-Levin N, Shapira Y, Gilburd B, Reuter S, Lavi I, Shoenfeld Y. The thrombophilic network of autoantibodies in celiac disease. BMC Med. 2013; 11: 89.
 
[3]  Katz KD, Rashtak S, Lahr BD et al. Screening for celiac disease in a North American population: sequential serology and gastrointestinal symptoms. Amer J Gastroentrol 2011; 106: 1333-1339.
 
[4]  Aggarwal S, Lebwohl B, Green PH. Screening for celiac disease in average-risk and high-risk populations. Therap Adv Gastroenterol. 2012; 5: 37-47.
 
[5]  Schuppan D, Zimmer K-P The diagnosis and treatment of celiac disease. Dtsch Arztebl Int. 2013; 110: 835-46.
 
[6]  Guandalini S, Assiri A. Celiac disease: a review. JAMA Pediatr. 2014; 168: 272-8.
 
[7]  Kocna P, Vanickova Z, Zima T. Laboratory screening markers in gastroenterology--state of the art. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013; 157: 91-7.
 
[8]  Gujral N1, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol. 2012; 18: 6036-59.
 
[9]  Giersiepen K, Lelgemann M, Stuhldreher N, Ronfani L, Husby S, Koletzko S, Korponay-Szabó IR; ESPGHAN Working Group on Coeliac Disease Diagnosis. Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. J Pediatr Gastroenterol Nutr. 2012; 54: 229-41.
 
[10]  Lewis NR, Scott BB. Meta-analysis: deamidated gliadin peptide antibody and tissue transglutaminase antibody compared as screening tests for coeliac disease. Aliment Pharmacol Ther. 2010; 31: 73-81.
 
[11]  Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, Bossuyt X. Diagnostic performance of IgG anti-deamidated gliadin peptide antibody assays is comparable to IgA anti-tTG in celiac disease. Clin Chim Acta.2010; 411: 931-5.
 
[12]  Villalta D, Alessio MG, Tampoia M, Tonutti E, Brusca I, Bagnasco M, Pesce G, Stella S, Bizzaro N. Testing for IgG class antibodies in celiac disease patients with selective IgA deficiency. A comparison of the diagnostic accuracy of 9 IgG anti-tissue transglutaminase, 1 IgG anti-gliadin and 1 IgG anti-deaminated gliadin peptide antibody assays. Clin Chim Acta.2007; 382: 95-9.
 
[13]  Villalta D, Alessio MG, Tampoia M, Tonutti E, Brusca I, Bagnasco M, Pesce G, Bizzaro N. Diagnostic accuracy of IgA anti-tissue transglutaminase antibody assays in celiac disease patients with selective IgA deficiency. Ann N Y Acad Sci. 2007; 1109: 212-20.
 
[14]  Reeves GE, Squance ML, Duggan AE, Murugasu RR, Wilson RJ, Wong RC, Gibson RA, Steele RH, Pollock WK. Diagnostic accuracy of coeliac serological tests: a prospective study. Eur J Gastroenterol Hepatol. 2006; 18: 493-501.
 
[15]  Volta U, Granito A, Parisi C, Fabbri A, Fiorini E, Piscaglia M, Tovoli F, Grasso V, Muratori P, Pappas G, De Giorgio R. J Deamidated gliadin peptide antibodies as a routine test for celiac disease: a prospective analysis. Clin Gastroenterol. 2010; 44: 186-90.
 
[16]  Bizzaro N1, Tozzoli R, Villalta D, Fabris M, Tonutti E. Cutting-edge issues in celiac disease and in gluten intolerance. Clin Rev Allergy Immunol. 2012; 42: 279-87.
 
[17]  Rozenberg O, Lerner A, Pacht A, Grinberg M, Reginashvili D, Henig C, Barak M. A novel algorithm for the diagnosis of celiac disease and a comprehensive review of celiac disease diagnostics. Clin Rev Allergy Immunol. 2012; 42: 331-41.
 
[18]  Rozenberg O, Lerner A, Pacht A, Grinberg M, Reginashvili D, Henig C, Barak M.A new algorithm for the diagnosis of celiac disease. Cell Mol Immunol.2011; 8: 146-9.
 
[19]  Barak M, Rozenberg O, Froom P, Grinberg M, Reginashvili D, Henig C, Pacht A, Lerner A. Challenging our serological algorithm for celiac disease (CD) diagnosis by the ESPGHAN guidelines. Clin Chem Lab Med. 2013; 51; e257-259.
 
[20]  Agardh D. Antibodies against synthetic deamidated gliadin peptides and tissue transglutaminase for the identification of childhood celiac disease. Clin Gastroenterol Hepatol. 2007; 5: 1276-81.
 
[21]  Niveloni S, Sugai E, Cabanne A, Vazquez H, Argonz J, Smecuol E, Moreno ML, Nachman F, Mazure R, et al. Antibodies against Synthetic Deamidated Gliadin Peptides as Predictors of Celiac Disease: Prospective Assessment in an Adult Population with a High Pretest Probability of Disease. Lin Chem 2007; 53: 2186-2192.
 
[22]  Holding S, Wilson F, Spradbery D. Clinical evaluation of the BioPlex 2200 Celiac IgA and IgG Kits - A novel multiplex screen incorporating an integral check for IgA deficiency. J Immunol Methods. 2014; 405: 29-34.
 
[23]  Kocna P1, Vanícková Z, Perusicová J, Dvorák M. Tissue transglutaminase-serology markers for coeliac disease. Clin Chem Lab Med. 2002; 40: 485-92.
 
[24]  Tonutti E, Bizzaro N. Diagnosis and classification of celiac disease and gluten sensitivity. Autoimmun Rev. 2014; 13: 472-476.
 
[25]  Vermeersch P, Geboes K, Mariën G, Hoffman I, Hiele M, Bossuyt X. Serologicaldiagnosis of celiac disease: comparative analysis of different strategies. Clin Chim Acta. 2012; 413: 1761-7.
 
[26]  Swallow K, Wild G, Sargur R, Sanders DS, Aziz I, Hopper AD, Egner W. Quality not quantity for transglutaminase antibody 2: the performance of an endomysial and tissue transglutaminase test in screening coeliac disease remains stable over time. Clinical and Experimental Immunology, 2012; 171: 100-106.
 
[27]  Matthias T, Neidhöfer S, Pfeiffer S, Prager K, Reuter S, Gershwin ME. Novel trends in celiac disease. Cell Mol Immunol. 2011; 8: 121-5.
 
[28]  Matthias T, Pfeiffer S, Selmi C, Eric Gershwin M. Diagnostic challenges in celiac disease and the role of the tissue transglutaminase-neo-epitope. Clin Rev Allergy Immunol.2010; 38: 298-301.
 
[29]  Tozzoli R, Kodermaz G, Tampoia M, Visentini D, Tonutti E, bizzaro N. [detection of autoantibodies specific for transglutaminase-gliadin peptides complex: a new way to explore the celiac iceberg.] It J Lab Med. 2010; 6; 28-35.
 
[30]  Remes-Troche JM, Ramírez-Iglesias MT, Rubio-Tapia A, Alonso-Ramos A, Velazquez A, Uscanga LF. Celiac disease could be a frequent disease in Mexico: prevalence of tissue transglutaminase antibody in healthy blood donors. J Clin Gastroenterol. 2006; 40: 697-700.
 
[31]  Remes-Troche JM, Rios-Vaca A, Ramírez-Iglesias MT, Rubio-Tapia A, Andrade-Zarate V, Rodríguez-Vallejo F, López-Maldonado F, Gomez-Perez FJ, Uscanga LF. High prevalence of celiac disease in Mexican Mestizo adults with type 1 diabetes mellitus. J Clin Gastroenterol. 2008; 42: 460-5.
 
[32]  Tozzoli R, Kodermaz G, Porcelli B et al. Clinical relevance and diagnostic accuracy of new ELISA method for the detection of autoantibodies to gliadin-transglutaminase complex. Proceedings of the 7thInternational Congress on autoimmunity, Ljubljana, 5-9 May, 2010.
 
[33]  Tonutti E, Visentini D, Fabris M et al. Antibodies to the transglutaminase-deamidated gliadin complex: a new serological approach to the diagnosis of celiac disease.Proceedings of the 7thInternational Congress on autoimmunity, Ljubljana, 5-9 May, 2010.
 
[34]  Lytton SD, Antiga E, Pfeiffer S, Matthias T, Szaflarska-Poplawska A, Ulaganathan VK, Placek W, Fabbri P, Hall R, Caproni M.Neo-epitope tissue transglutaminase autoantibodies as a biomarker of the gluten sensitive skin disease-dermatitis herpetiformis. Clin Chim Acta. 2013; 415: 346-349.