Skip to main content
SpringerLink
Log in

Anti-endomysial Antibody Negative Celiac Disease

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Anti-endomysium antibodies (AEM) fail to identify all untreated celiac disease (CD) patients. This study aims to determine if additional serology, in particular, IgA anti-tissue transglutaminase (tTG) antibodies, increases detection. Fifty-three biopsy-proven untreated CD patients (39 women, 14 men; median age 51 years) and 65 control patients with normal duodenal histology (46 women, 19 men; age range 17–90 years, median 45 years) were prospectively studied. Serum total IgA, IgA anti-tTG, IgA AEM, IgA anti-gliadin (AGA) and IgG AGA antibodies were measured. Thirteen (25%) CD patients were AEM negative. None were IgA deficient. Three AEM-negative CD patients had a raised IgA anti-tTG and IgA AGA. IgG AGA was raised in 10 AEM-negative CD patients, but also in 14/65 (22%) of controls. In conclusion, AEM-negative CD is common and detection is only modestly enhanced by testing for IgA anti-tTG antibodies. Duodenal biopsy is still recommended for the accurate diagnosis of CD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Walker-Smith JA, Guandalini S, Schmitz J, Shmerling DH, Visakorpi JK: Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child 65:909–911, 1990

    Google Scholar 

  2. Chorzelski TP, Beutner EH, Sulej J, Tchorzewska H, Jablonska S, Kumar V, Kapuscinska A: IgA anti-endomysium antibody. A new immunological marker of dermatitis herpetiformis and coeliac disease. Br J Dermatol 111:395–402, 1984

    Google Scholar 

  3. Unsworth DJ: Serological diagnosis of gluten sensitive enteropathy. J Clin Pathol 49:704–711, 1996

    Google Scholar 

  4. Sulkanen S, Collin P, Laurila K, Maki M: IgA and IgG-class antihuman umbilical cord antibody tests in adult coeliac disease. Scand J Gastroenterol 33:251–254, 1998

    Google Scholar 

  5. Whelan A, Willoughby R, Weir D: Human umbilical vein endothelial cells: A new easily available source of endomysial antigens. Eur J Gastroenterol Hepatol 8:961–966, 1996

    Google Scholar 

  6. Valdimarsson T, Franzen L, Grodzinsky E, Skogh T, Strom M: Is small bowel biopsy necessary in adults with suspected celiac disease and IgA anti-endomysium antibodies? 100% positive predictive value for celiac disease in adults. Dig Dis Sci 41(1):83–87, 1996

    Google Scholar 

  7. de Lecea A, Ribes-Koninckx C, Polanco I, Calvete JF: Serological screening (antigliadin and antiendomysium antibodies) for non-overt coeliac disease in children of short stature. Acta Paediatr Suppl 412:54–55, 1996

    Google Scholar 

  8. Ferreira M, Lloyd Davies S, Butler M, Scott D, Clark M, Kumar P: Endomysial antibody: Is it the best screening test for coeliac disease? Gut 33:1633–1637, 1992

    Google Scholar 

  9. Rostami K, Kerckhaert J, Tiemessen R, Meijer JWR, Mulder CJJ: The relationship between anti-endomysium antibodies and villous atrophy in coeliac disease using both monkey and human substrate. Eur J Gastroenterol Hepatol 11:439–442, 1999

    Google Scholar 

  10. Rostami K, Kerckhaert J, von Blomberg BME, Meijer JWR, Wahab P, Mulder CJJ: SAT and serology in adult coeliacs, seronegative coeliac disease seems a reality. Neth J Med 53:15–19, 1998

    Google Scholar 

  11. Mulder CJJ, Rostami K, Marsh MN: When is a coeliac a coeliac? Gut 42:594, 1998

    Google Scholar 

  12. Cataldo F, Ventura A, Lazzari R, Balli F, Nassimbeni G, Marino V: Antiendomysium antibodies and coeliac disease: solved and unsolved questions. An Italian multicentre study. Acta Paediatr 84:1125–1131, 1995

    Google Scholar 

  13. Dieterich W, Ehnis T, Bauer M, Donner P, Volta U, Riecken EO, Schuppan D: Identification of tissue transglutaminase as the autoantigen of coeliac disease. Nat Med 3(7):797–801, 1997

    Google Scholar 

  14. Folk JE: Structure and Catalytic Properties of Hepatic Transglutaminase. Ann NY Acad Sci 202:59–76, 1972

    Google Scholar 

  15. D'Argenio G, Sorrentini I, Ciacci C, Mazzacca G: Transglutaminase activity along the rat small bowel and cellular location. Enzyme 39:227–230, 1988

    Google Scholar 

  16. Patel EK, Bruce SE, Bjarnason I, Peters TJ: Rat Gastrointestinal transglutaminase: Demonstration of enzyme activity and cell and tissue distributions. Cell Biochem Funct 3:199–203, 1985

    Google Scholar 

  17. Bruce SE, Bjarnason I, Peters TJ: Human jejunal transglutaminase: Demonstration of activity, enzyme kinetics and substrate specificity with special relation to gliadin and coeliac disease. Clin Sci 68:573–579, 1985

    Google Scholar 

  18. Collin P, Maki M, Keyrilainen O, Hallstrom O, Reunala T, Pasternack A: Selective IgA deficiency and coeliac disease. Scand J Gastroenterol 27:367–371, 1992

    Google Scholar 

  19. Cataldo F, Marino V, Bottaro G, Greco P, Ventura A: Celiac disease and selective immunoglobulin A deficiency. J Pediatr 131(2):306–308, 1999

    Google Scholar 

  20. Dick HM, Fraser NG, Murray D: Immunofluorescent antibody studies in dermatitis herpetiformis. Br J Dermatol 81(9):692–696, 1969

    Google Scholar 

  21. O'Mahoney S, Arranz E, Barton JR, Ferguson A: Dissociation between systemic and mucosal humoral immune responses in celiac disease. Gut 32:29–35, 1991.

    Google Scholar 

  22. Jones RG, Payne RB: Data for diagnosis and monitoring. In Clinical Investigation and Statistics in Laboratory Medicine. RG Jones, RB Payne (eds). London, ACB Venture Publications, 1997: pp 66–123

    Google Scholar 

  23. Kumar V, Lerner A, Valeski JE, Beutner EH, Chorzelski TP, Rossi T: Endomysial antibodies in the diagnosis of celiac disease and the effect of gluten on antibody titers. Immunol Invest 18:(1–4)533-544, 1989

    Google Scholar 

  24. Rittmeyer C, Rhoads JM: IgA deficiency causes false-negative endomysial antibody results in celiac disease. J Pediatr Gastroenterol Nutr 23:504–506, 1996

    Google Scholar 

  25. Sulkanen S, Halttunen T, Laurila K, Kolho K, Korponay-Szabo IL, Sarnesto A, Savilahti E, Collin P, Maki M: Tissue transglutaminase autoantibody enzyme-linked immunosorbent assay in detecting celiac disease. Gastroenterology 115:1322–1328, 1998

    Google Scholar 

  26. Dieterich W, Laag E, Schopper H, Volta U, Ferguson A, Gillett H, Riecken EO, Schuppan D: Autoantibodies to tissue transglutaminase as predictors of celiac disease. Gastroenterology 115:1317–1321, 1998

    Google Scholar 

  27. Lock RJ, Pitcher MCL, Unsworth DJ: IgA tissue transglutaminase as a diagnostic marker of gluten sensitive enteropathy. J Clin Pathol 52:274–277, 1999

    Google Scholar 

  28. Troncone R, Maurano F, Rossi M, Micillo M, Greco L, Auricchio S, Salerno G, Salvatore F, Sacchetti L: IgA antibodies to tissue transglutaminase: An effective diagnostic test for celiac disease. J Pediatr 134:166–171, 1999

    Google Scholar 

  29. Biagi F, Ellis HJ, Yiannakou JY, Brusco G, Swift GL, Smith PM, Corazza GR, Ciclitira PJ: Tissue transglutaminase antibodies in celiac disease. Am J Gastroenterol 94(8):2187–2192, 1999

    Google Scholar 

  30. Rostami K, Kerckhaert J, Tiemessen R, von Blomberg BME, Meijer JWR, Mulder CJJ: Sensitivity of antiendomysium and antigliadin antibodies in untreated coeliac disease: Disappointing in clinical practice. Am J Gastroenterol 94(4):888–894, 1999

    Google Scholar 

  31. Rostami K, Stapel S, von Blomberg MBE, Meijer JWR, Ten Kate SJW, Mulder CJJ: Antibodies to tissue transglutaminase and histogenesis of coeliac disease. Department of Hepatogastroenterology Rijnstate Hospital Arnhem and Academic Medical Centre Amsterdam, The Netherlands, 1998, pp 101–114

    Google Scholar 

  32. Grefte JMM, Bouman JG, Grond J, Jansen W, Kleibeuker JH: Slow and incomplete histological and functional recovery in adult gluten sensitive enteropathy. J Clin Pathol 41:886–891, 1988

    Google Scholar 

  33. Halttunen T, Maki M: Serum immunoglobulin A from patients with celiac disease inhibits Human T84 intestinal crypt epithelial cell differentiation. Gastroenterology 116: 566–572, 1999

    Google Scholar 

  34. Webster ADB, Slavin G, Shiner M, Platts-Mills TAE, Asherson GL: Coeliac disease with severe hypogammaglobulinaemia. Gut 22:153–157, 1981

    Google Scholar 

  35. Holmes GKT, Prior P, Lane MR, Pope D, Allan RN: Malignancy in coeliac disease-effect of a gluten free diet. Gut 30:333–338, 1989

    Google Scholar 

  36. Leonard JN, Tucker WFG, Fry JS, Coulter CAE, Boylston AW, McMinn RMH, Haffenden GP, Swain AF, Fry L: Increased incidence of malignancy in dermatitis herpetiformis. BMJ 286:16–18, 1983

    Google Scholar 

  37. Swinson CM, Slavin G, Coles EC, Booth CC: Coeliac disease and malignancy. Lancet 1:111–115, 1983

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastrointestinal Unit, Department of Medical Sciences, University of Edinburgh, Scotland UK

    Anna Dahele, Kathleen Kingstone, John Bode, Diane Anderson & Subrata Ghosh

  2. Department of Medical Microbiology, Western General Hospital, Edinburgh, EH4 2XU, Scotland, UK

    Anna Dahele, Kathleen Kingstone, John Bode, Diane Anderson & Subrata Ghosh

Authors
  1. Anna Dahele
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathleen Kingstone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Bode
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Diane Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Subrata Ghosh
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dahele, A., Kingstone, K., Bode, J. et al. Anti-endomysial Antibody Negative Celiac Disease. Dig Dis Sci 46, 214–221 (2001). https://doi.org/10.1023/A:1005589202529

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1005589202529

Search

Navigation