King Saud University, Saudi Arabia
Ghadah is a 4th year medical student at King Saud University, Riyadh ,Saudi Arabia.
Background: Although small bowel biopsy is considered as the gold standard for diagnosis of celiac disease (CD) detection of autoantibodies is usually the initial step in diagnosis of CD.
Objective: This study was performed to assess the performance of each celiac specific auto antibody against the gold standard.
Methods: This retrospective study included 267 patients with clinical suspicion of CD who underwent investigations for diagnosis of CD between March 2011 and June 2014 at King Khalid University Hospital, Riyadh. The panel of celiac specific antibodies tested comprised of anti-gliadin IgG and IgA, anti-tissue Transglutaminase IgG (anti-tTGG) and IgA (anti-tTGA), anti-endomysium and anti-reticulin antibodies. Anti-endomysium and anti-reticulin antibodies were tested by immunofluorescence and the others were assessed by ELISA.
Results: Out of the total only 61 patients including 35 females and 26 males (mean age 26+11 years) were subjected to small bowel biopsy testing with 37 positive and 24 negative results. Among the six autoantibodies assessed anti-tTGA had a sensitivity of 97.3%, specificity of 83%, positive predictive value (PPV) of 90% and a negative predictive value (NPV) of 95%. Anti-endomysium antibody had a sensitivity of 62.1%, specificity of 95.7%, PPV of 95.8% and NPV of 62.2%. None of the other autoantibodies displayed any notable performance. Receiver operator curve analysis also confirmed the diagnostic accuracy of anti-tTGA with 90.3% area under curve (AUC) followed by anti-endomysium antibody with 70% AUC.
Conclusion: In the presence of relevant history anti-TGA as a single test can be used as an initial screening test for CD.