The Role of Serology in Celiac Disease Screening, Diagnosis and Follow-up

Carme Farré Masip

Resumen


Serological markers are an essential part of the diagnostic workup for coeliac disease (CD). Diverse clinical forms can be detected at any age in genetcally susceptible individuals who have gluten in their diet.

Quantitative, automated IgA-class anti-tissue transglutaminase antibody testing is the recommended serological marker for CD detection, replacing the classical antiendomysial antibody test determined by indirect immunofluorescence assay. Anti-deaminated gliadin peptide antibodies improve the specificity of anti-gliadin antibodies, but lack the diagnostic eficacy of anti-transglutaminase antibodies.

Anti-transglutaminase antibodies should be determined in patents with clinical suspicion of CD, in CD-risk groups and in patients with CD-associated diseases.

Laboratories carrying out these assays must meet the following criteria: 1) Participation in quality control programmes; 2) Use of appropriate reference values; 3) Quantitative monitoring of gluten free diets; 4) Results comparable with other commercial tests, in view of the lack of a calibraton standard.

The choice of a commercial test should take into account the type of antigen(s) calibrator, level of accuracy, linearity and detection limits, and any interferences.

In clinical practice, we do not recommend the use of mixed tests to screen for antibodies and isotypes, due to their contrasting signifcance and kinetics. Similarly, we advise against rapid immunochromatographic tests, to avoid diagnostc confusion.

Finally, it should be noted that anti-transglutaminase antibodies are only of limited use in adults and patients with partial villous atrophy on biopsy.


Palabras clave


serology, celiac disease, screening, diagnosis, follow-up

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