Hill, P.G.; Holmes, G.K.T.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA99
Academic Journal
Introduction: We recently confirmed the superior diagnostic accuracy of tissue transglutaminase antibody (TGA), using human antigen, for the diagnosis of coeliac disease (CD) with selected sampies? Here we report the first 6 months experience of TGA as our first line test for CD. Methods and Serum Samples: TGA was measured using the Celikey kit with recombinant human tissue transglutaminase as antigen (Pharmacia Diagnostics, Milton Keynes, UK). Levels > 5 units/mL are considered abnormal. Endomysial antibody (EMA) was measured by indirect immunofluorescence on monkey oesophagus slides (The Binding Site, Birmingham, UK) at a 1:10 serum dilution on all samples with TGA > 2.9 units/mL. Serum samples received From April to Sept 2002 in the investigation of adults from primary or secondary care were included in this review. Results: 1601 samples were analysed in this 6 month period, the median level was 0.6 units/mL; 1542 (96.3%) had results of < 3 units/mL. The table summarises the results and small bowel biopsy Findings thus far. IgA deficiency can be suspected from a Iow optical density reading in the assay; 14% of all samples required total IgA measurement. 3 new case of IgA deficiency were detected. Conclusions: TGA levels of twice the upper limit of normal (10 u/mL) are invariably diagnostic of CD raising the question whether biopsy is still essential for the diagnosis. Introduction of the assay has fulfilled expectations of high specificity and has significantly reduced the EMA workload. However, we appear to be missing the expected small proportion of subjects with CD who are EMA negative at diagnosis.


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