It may be time to change the way we screen for celiac disease (CD), according to the results of a population-based study reported in the November issue of the American Journal of Gastroenterology.
Testing for tissue transglutaminase (tTG) antibodies first may obviate the need to screen with antigliadin IgA. The editorialist agrees and makes suggestions for incorporating this into clinical practice.
“Our data showed that a new screening protocol using [anti-tTG] as first line followed by endomysial antibodies is a cost-effective screening and yielded more realistic figures of prevalence for CD in a community setting than the classic three-level sequential evaluation using antigliadin antibodies,” write Juan C. Gomez, MD, and colleagues from San Martin Hospital in La Plata, Argentina.
Using a community-based population, the investigators screened 1,000 consecutive subjects who had blood drawn at a centralized laboratory for mandatory prenuptial testing. Age range was 16 to 71 years, and there were 497 women. Serum samples from all subjects were screened with two different protocols.
Three-level classic screening consisted of parallel use of IgG and IgA antigliadin antibodies, followed by endomysial antibodies (EmA) and total serum IgA in positive patients, and finally intestinal biopsy of patients with positive EmA. The study screening protocol consisted of the parallel use of a commercial guinea pig anti-tTG antibody and total serum IgA as first line, with EmA (type IgA and/or IgG) for positive patients, and finally, intestinal biopsy.
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