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Gluten-Free Diet Recommended for Patients with Serum IgA Endomysial Antibodies but Normal Duodenal Villi Biopsy

The following abstract was submitted to celiac.com directly by William Dickey, Ph.D., a leading celiac disease researcher and gastroenterologist who practices at Altnagelvin Hospital, Londonderry, Northern Ireland.

Scandinavian Journal of Gastroenterology 2005; 40: 1240-3.
Dickey W, Hughes DF, McMillan SA.

Celiac.com 09/27/2005 - What does a positive endomysial antibody (EmA) test mean if the biopsy does not show villous atrophy? The authors studied 35 patients where this was the case. In the authors practice, these patients account for 10% of all EmA positives.

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Firstly, the lack of villous atrophy did not necessarily mean a normal biopsy: 14 patients had excess inflammatory cells (lymphocytes) consistent with a mild abnormality of gluten sensitivity.

Secondly, many of these patients had typical celiac features: twelve had a family history of celiac, five had dermatitis herpetiformis and thirteen had osteopenia or osteoporosis on DEXA scan.

After discussion, 27 patients opted to take a gluten-free diet from the first biopsy: 26 of these had clinical improvement. Seven of eight patients who persisted with a normal diet developed villous atrophy on follow-up biopsies.

The authors conclude that a positive EmA result indicates gluten sensitivity even if biopsies do not show villous atrophy. While a biopsy remains important as a baseline reference, these patients should be offered a gluten-free diet to allow clinical improvement and prevent the development of villous atrophy. There may be no such thing as a "false positive" EmA, although the authors emphasise that the same conclusion cannot yet be applied to tissue transglutaminase antibody results.

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I couldn't have said this better!

That value/score is a very, very strange way of reporting total IgA!

Better to catch a celiac disease diagnosis early. Experts do recommend the testing of all first-degree relatives even if asymptomatic and while on a full gluten-containing diet. I had my kid screened and requested a full panel since I test oddly. She was also screened for anemia. That was ab...

Non alcoholic liver disease is associated with celiac disease. My liver numbers were elevated in the year or two before diagnosis and I was dx'd with fatty liver (non alcoholic). After I went gluten free, my numbers came right back down to normal. I also had microscopic blood in my urine & had al...