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Is DGP Serological Test the Wave of the Future for Celiac Disease Testing?

Celiac.com 03/11/2010 - Many people are confused about which tests provide the most accurate results for a celiac disease diagnosis. In a recent study by a team at the Department of Gastroenternology and Internal Medicine, St. Orsola-Malpigihi Hospital, University of Bologna, Bologna, Italy, researchers evaluated  current testing methods, and made some conclusions about celiac testing that may shed light on the subject for those of us overwhelmed by current conflicting information.

Duodenal biopsy is considered to be the universal 'gold standard' for celiac diagnosis. However, in recent years the importance of  serological testing has been been emphasized as a reliable marker for antibodies as well. The tTG antibodies of IgA class are currently recognized to be the most effective test for celiac screening, resulting in up to 95% accuracy.  Although, a new serological test, DGP, is now being investigated as a more reliable alternative to tTG.

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A study was devised to compare the effectiveness of DGP antibodies with that of tTG antibodies, and used a meta-analysis of  eleven studies that were published between 1998 and 2008. The study analyzed the results of 937 patients with untreated celiac, and 1,328 control subjects. The analysis of the eleven studies showed that IgA tTG antibodies revealed a higher likelihood ratio (LR) than IgA DGP antibodies, and IgA tTG antibodies exhibited a lower LR than IgA DGP antibodies. The data between the two antibody tests validates that IgA tTG continues to display the most accurate diagnostic tests for a positive celiac diagnosis, as well as for excluding a negative celiac diagnosis.  However  IgG DGP antibody tests were shown to be more effective at identifying 'false negatives' and had more success in determining celiac in patients that had IgA deficiency, and in children under two years old.

The results of these tests clearly demonstrate that IgA DGP does not offer any advantages to the IgA tTG antibodies, and is actually less accurate and more expensive. However, IgG  DGP antibodies present an invaluable tool  in screening for celiac disease in cases where IgA tTG tests fail. Eventually, a new antibody screening will hopefully be designed which combines IgA tTG and IgG DGP, and reduces the number of tests currently used in celiac screening. However, intestinal biopsy is always required to confirm the presence of celiac disease no matter what serological tests are involved.

Source:
http://www.ncbi.nlm.nih.gov/pubmed/20136587

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2 Responses:

 
acousticmom
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said this on
01 Apr 2010 6:08:02 AM PDT
I could use some clarification here:

"The analysis of the eleven studies showed that IgA tTG antibodies revealed a higher likelihood (LR) ratio than IgA DGP antibodies, and IgA tTG antibodies exhibited a lower LR than IgA DGP antibodies."

 
Destiny
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated ( Author)
said this on
01 Apr 2010 10:49:46 AM PDT
Likelihood ratio (LR) means that there is a likelihood that a given test result (in this case, tTG & DGP) would be expected in a patient with celiac disease compared with the likelihood that the same result would be expected to be found in a patient without celiac disease. Therefore, what the results are saying is that tTG shows both a higher and lower likelihood ratio than DGP, making it a more effective test for determining the presence of celiac as well as the absence of celiac disease.




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