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Anti-transglutaminase (tTG) and Anti-endomysium (EMA) Antibodies not Useful in Determining Histologic Recovery in Celiac Disease

J Clin Gastroenterol. 2003 Nov-Dec;37(5):387-91
Tursi A, Brandimarte G, Giorgetti GM.

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Celiac.com 11/18/2003 - According to the results of an Italian study neither anti-transglutaminase (tTG) nor Anti-endomysium (EMA) antibody levels should be used to determine the state of recovery of gluten-free celiacs. The study looked at 42 consecutively biopsy and blood antibody diagnosed celiac disease patients who went on gluten-free diets, and were then evaluated at 6, 12, and 18 months using anti-transglutaminase (tTG) antibodies and EGDscopy (multiple bioptic samples). For comparison sorbitol H2-breath tests (H2-BT) and anti-endomysium (EMA) antibody tests were also carried out. The results:

(A)nti-tTG and EMA were ineffective in assessing the histologic recovery at each follow-up visit (P = NS), while sorbitol H2-BT seems more effective than anti-tTG and EMA in this field (P < 0.0001 sorbitol H2-BT versus anti-tTG and versus EMA at 18 months after gluten withdrawal). Thirty-eight of 42 (90.47%) patients adhered to a strict GFD. Four patients were found to have occasional dietary transgression, and in all we noted a progressive decreasing of anti-tTG after 6 months of GFD and negative anti-tTG after 12 months of GFD, but sorbitol H2-BT persisted being positive during the entire follow-up. Intestinal damage persisted during the follow-up, despite anti-tTG and EMA negativity, and worsened in the presence of dietary lapses. Anti-tTG does not seem effective to assess histologic recovery in the follow-up of celiac patients after they have started GFD due to its poor correlation with histologic damage.

These results indicate that the biopsy is still the best method to determine recovery from celiac disease, and surprisingly the non-invasive sorbitol H2-breath test was better than both anti-tTG and EMA serology testing in this regard.

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