Copyright
©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
Endomysial antibodies predict celiac disease irrespective of the titers or clinical presentation
Kalle Kurppa, Tiia Räsänen, Pekka Collin, Sari Iltanen, Heini Huhtala, Merja Ashorn, Päivi Saavalainen, Katri Haimila, Jukka Partanen, Markku Mäki, Katri Kaukinen
Kalle Kurppa, Tiia Räsänen, Sari Iltanen, Merja Ashorn, Markku Mäki, Pediatric Research Centre, University of Tampere and Tampere University Hospital, Fin-33014, Tampere, Finland
Pekka Collin, Katri Kaukinen, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Fin-33014, Tampere, Finland
Heini Huhtala, Tampere School of Public Health, University of Tampere, Fin-33014, Tampere, Finland
Päivi Saavalainen, Department of Medical Genetics and Research Program for Molecular Medicine, University of Helsinki, Fin-00014, Helsinki, Finland
Katri Haimila, Jukka Partanen, Research and Development, Finnish Red Cross Blood Service, Fin-00310, Helsinki, Finland
Author contributions: Kurppa K, Räsänen T, Collin P, Iltanen S, Huhtala H, Ashorn M, Saavalainen P, Haimila K, Partanen J, Mäki M and Kaukinen K designed the research, contributed to the acquisition of the data and performed critical revision of the manuscript; Kurppa K, Huhtala H and Kaukinen K analyzed the data; Kurppa K and Kaukinen K wrote the paper.
Supported by The Academy of Finland Research Council for Health; the Competitive Research Funding of the Pirkanmaa Hospital District; the Sigrid Juselius Foundation; the Foundation for Paediatric Research; the National Graduate School of Clinical Investigation; the Ehrnrooth Foundation; the Finnish Gastroenterology Society; the Finnish Pediatric Society and the Finnish Celiac Society
Correspondence to: Katri Kaukinen, MD, PhD, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Fin-33014, Tampere, Finland. katri.kaukinen@uta.fi
Telephone: +358-3-35518403 Fax: +358-3-35518402
Received: July 28, 2011
Revised: November 2, 2011
Accepted: March 10, 2012
Published online: May 28, 2012
AIM: To investigate the association between serum antibody levels and a subsequent celiac disease diagnosis in a large series of children and adults.
METHODS: Besides subjects with classical gastrointestinal presentation of celiac disease, the study cohort included a substantial number of individuals with extraintestinal symptoms and those found by screening in at-risk groups. Altogether 405 patients underwent clinical, serological and histological evaluations. After collection of data, the antibody values were further graded as low [endomysial (EmA) 1:5-200, transglutaminase 2 antibodies (TG2-ab) 5.0-30.0 U/L] and high (EmA 1: ≥ 500, TG2-ab ≥ 30.0 U/L), and the serological results were compared with the small intestinal mucosal histology and clinical presentation.
RESULTS: In total, 79% of the subjects with low and 94% of those with high serum EmA titers showed small-bowel mucosal villous atrophy. Furthermore, 96% of the 47 EmA positive subjects who had normal mucosal villi and remained on follow-up either subsequently developed mucosal atrophy while on a gluten-containing diet, or responded positively to a gluten-free diet.
CONCLUSION: Irrespective of the initial serum titers or clinical presentation, EmA positivity as such is a very strong predictor of a subsequent celiac disease diagnosis.
