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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
Rating: ratingfullratingfullratingfullratingemptyratingempty Unrated
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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Hello I was diagnosed Dec 15 of last year and went totally gluten-free the next day. I actually got worse before I got better - it's a steep learning curve - but now, 4 1/2 months later I'm finally seeing improvement. Hang in there.

Called my GI doctor today to make sure he is going to look at my small intestine and do biopsy for Celiac for my EGD and he is. Thanks for the tip everyone about have to start eating gluten again. The office told me to break my gluten free diet and start eating gluten everyday until my EGD. Here's to being miserable again for a few weeks ???

I can completely relate! The horrible mental effects that I have been living with for years is the absolute worst side effect of eating gluten, HANDS DOWN. Worse than the endless tummy aches, worse than the constant diarrhea, worse than the week long migraines, worse than the daily fatigue and body pain.... I honestly though there was something seriously wrong with me and hated my life because of how I felt mentally. I always felt like I was drowning, not in control of my thoughts, trapped in some unexplained misery. My head was always so cloudy, and I was mad because I always felt so slow and stupid. I would feel so lethargic and sad and empty while at the same time be raging inside, wanting to rip out of my own skin. I was mean, terrible, would snap at the people closest to me for no good reason and just felt like I hated everyone and everything. Think of how crappy you feel when you have a terrible cold and flu - I felt that crappy, but mentally. Some days were really bad, some were mild. I always thought it was because I was getting a migraine, or because I had a migraine, or because I had just overcome a migraine, because I didn't sleep well, because....always a random reason to justify why we have all these weird unrelated symptoms before we get diagnosed. I'm happy to say that I have been gluten-free for about 2 months now and though I am not symptom free, the first thing that improved was my mood. I no longer feel foggy and miserable. For the first time in years, my head is clear, I can actually think, and I feel positive and like I am in control of what's going on in my head. I don't hate the world. I don't spend every day bawled up on the corner of the couch depressed and angry. The release of these horrible symptoms is enough to never make me want to cheat, no matter what I have to miss out on. So insane how a little minuscule amount of a stupid protein can wreck such havoc.

I wanted to collect some of the info on NCGI in one place so that visitors who test negative but may still have an issue with gluten can be directed there. I'll add to this post as I find new links, but feel free to add or contribute anything you think may be of use! Matt --- Useful links: An overview from Alessio Fasano, one of the world's leading researchers on celiac and gluten sensitivity: https://www.youtube.com/watch?v=VvfTV57iPUY Umberto Volta, another leading researcher in the field gives some of the latest findings about NCGI: Presentation slides from Dr Volta's visit to Coeliac UK - NCGS about halfway through A scholarly overview from celiac disease magazine: https://www.researchgate.net/profile/Knut_Lundin/publication/232528784_Non-celiac_Gluten_Sensitivity/links/09e415098bbe37c05b000000.pdf A good overview from a sceptical but fair perspective: https://sciencebasedmedicine.org/a-balanced-look-at-gluten-sensitivity/ Another overview: https://celiac.org/celiac-disease/understanding-celiac-disease-2/non-celiac-gluten-sensitivity-2/ University of Chicago's excellent celiac site's take: http://www.cureceliacdisease.org/category/faq-non-celiac-gluten-sensitivity/ A compelling account in the British Medical Journal from an NCGI patient: http://www.bmj.com/content/345/bmj.e7982 Here's some positive news about a potential new test: http://www.medicaldaily.com/non-celiac-gluten-insensitivity-blood-test-392850 NCGI in children: NCGI and auto immune study: https://www.ncbi.nlm.nih.gov/pubmed/26026392 Also consider: Fodmaps: http://www.kcl.ac.uk/lsm/research/divisions/dns/projects/fodmaps/faq.aspx This Monash study: http://fodmapmonash.blogspot.co.uk/2015/03/the-truth-behind-non-celiac-gluten.html suggested some who think they're reacting to gluten should actually be reducing fodmaps Sibo: http://www.webmd.boots.com/digestive-disorders/small-intestinal-bacteria-sibo

I was just diagnosed in March and I totally feel you. I'm having a hard enough time with determining which lip glosses are safe, let alone all my face products etc. I feel like this 'grey area' is the biggest annoyance with Celiac. So many foods/cosmetics I thought were safe after reading the ingredient list are actually not safe at all! One website says it's safe, one says its not. All these unfamiliar ingredients and even after googling term after term still so many grey areas!! I'm sure in time it gets easier and second nature and you learn by trial and error but holy this constant uncertainty is super annoying haha.