The Predictive Value of Serological Markers in Diagnosis of Celiac Disease

Introduction Celiac disease is an autoimmune inflammatory disease of the small intestine that is precipitated by the ingestion of gluten, a component of wheat protein, in genetically susceptible persons. Serologic tests for antibodies against Endomysium, Reticulin, and Gliadin identify most patients with the disease. Early diagnosis and management are important to prevent serious sequelae of malabsorption, such as osteoporosis and anemia. Aim of the study To compare the sensitivity, specificity, and predictive value of anti-reticulin and anti-gliadin antibodies according to anti-endomysium antibodies, in patients investigated for celiac disease antibodies. Patients and methods Study population included 509 celiac disease patients (236 males& 273 females) who were referred to the clinical pathology department, from January till December 2015 for serological detection of auto-antibodies. Anti-Gliadin (IgG& IgA) measured by Enzyme Linked Immunosorbent Assay (ELISA), whereas Anti-Endomyseal IgA& Anti-Reticulin IgA were detected by indirect immunofluorescent technique. Results Most the cases for celiac disease were reported in the age group (1-10) years as antibodies against Gliadin (IgG, IgA), Anti-Endomysial IgA antibodies and anti-Reticulin IgA were detected in 130 (66.7 %), 127 (65.8 %), 39 (79.6 %) and 49 (68.1 %) respectively. Both anti-Gliadin IgA and anti Reticulin were detected significantly in females p values (0.047, 0.008) respectively. The study showed that anti-Gliadin IgA is the most sensitive according to anti Endomysial IgA and anti Reticulin was the most specific for screening of celiac disease. While Receiver Operating Characteristic (ROC) curve showed that anti-gliadin IgA had the best sensitivity and specificity according to anti Endomysium test results. Conclusions The predictive values of the serological celiac disease tests showed that anti Gliadin IgA had the best sensitivity& specificity according to traditional anti Endomysium antibody test results. Celiac disease, Endomysial Antibodies, Gliadin Antibodies, Reticulin antibodies.