Celiac.com 08/12/2011 - Although serological analysis is used in diagnosing celiac disease, histopathology is regarded as most reliable.
A team of researchers set out to assess the clinical, pathological and serological spectrum of celiac disease in a general population via prospective study (Kalixanda study).
For their study, the team evaluated a random sample of 1000 adults from the general population by upper endoscopy, duodenal biopsy, and serological analysis of tissue transglutaminase (tTg) levels. They screened samples that were tTg+ for endomysial antibody (EMA) levels.
The baseline value for celiac diagnosis was villous atrophy with 40 intraepithelial lymphocytes (IELs)/100 enterocytes (ECs).
The team found 33 subjects with tTg+ and 16 with EMA+. Their histological analysis showed 7/1000 subjects (0.7%) with celiac disease, all of whom showed tTg+ and 6 of 7 of whom showed EMA+.
Another 26 subjects showed tTg+, 7 of 26 showing EMA+. The team then addressed these cases with a second quantitative pathology study, this one a nested case-control design, that used a celiac diagnosis baseline of 25 IELS/100 ECs. Under this criteria, all 13 samples that were tTg+ and EMA+ had more than 25 IELs/100ECs.
A total of 16 subjects (1.6%) showed serological and histological evidence of gluten-sensitive enteropathy. The team quantified IELs in duodenal biopsy samples from 500 seronegative individuals. A total of 19 (3.8%) of those subjects had >25 IELs and lymphocytic duodenosis (LD).
A celiac diagnosis level of â‰¥25 IELs/100 ECs was strongly associated with serological indicators of celiac disease, while a higher IEL threshold missed half of cases.
Quantification of tTg is a sensitive test for celiac disease, and diagnosis can be confirmed by observation of â‰¥25 IELs/100ECs in duodenal biopsy. Lymphocytic enteropathy in the form of both celiac disease and Lymphocytic duodenitis, is common, occurring in about 5.4% of the general population.