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Deamidated Gliadin Peptide Antibodies as a Routine Test for Celiac Disease: A Prospective Analysis

Volta, Umberto MD; Granito, Alessandro MD; Parisi, Claudia MD; Fabbri, Angela MD; Fiorini, Erica MD; Piscaglia, Maria MD; Tovoli, Francesco MD; Grasso, Valentina MSc; Muratori, Paolo MD; Pappas, Georgios MD; De Giorgio, Roberto MD, PhD

Journal of Clinical Gastroenterology: March 2010 - Volume 44 - Issue 3 - pp 186-190
doi: 10.1097/MCG.0b013e3181c378f6
ALIMENTARY TRACT: Original Articles

Goals: This study was designed to establish whether deamidated gliadin peptide antibodies (DGP-AGA) could improve the serologic workup for celiac disease (CD).

Background: The best serologic approach for CD screening is currently based on the combined detection of tissue transglutaminase (tTGA), endomysial (EmA), and gliadin antibodies (AGA).

Study: One hundred forty-four consecutive patients with gastrointestinal and extraintestinal signs suggestive for CD were investigated using serologic tests, that is, IgG and IgA DGP-AGA, IgA tTGA, IgA EmA, and duodenal biopsy.

Results: Forty-eight out of 144 patients (33%) had CD with different severity of villous atrophy. IgA tTGA showed 93.7% sensitivity compared with 91.6% for IgA EmA, 84.3% for IgA DGP-AGA, and 82.3% for IgG DGP-AGA. Of the 3 cases negative for IgA tTGA, IgA EmA, and IgA DGP-AGA, 2 had total IgA deficiency, although both were positive for IgG DGP-AGA. IgG DGP-AGA showed a very high specificity for CD (98.9%), not only superior to IgA DGP-AGA (79.8%), but also to IgA tTGA (96.6%) and very close to IgA EmA (100%).

Conclusions: Our prospective study shows that the combined search for IgA tTGA and IgG DGP-AGA provides the best diagnostic accuracy for CD, allowing the identification of all CD cases---except one---with a very high specificity. The serologic workup for CD screening could be significantly improved by the routine introduction of IgG DGP-AGA together with IgA tTGA, thus reducing the number of tests and with an obvious advantage in terms of cost-efficacy.

Department of Clinical Medicine, University of Bologna, Bologna, Italy

Grant Support: Italian Ministry of University and Research (COFIN Projects to R.De.G.), and R.F.O. funds from the University of Bologna (to R.De.G.). R.De.G. is a recipient of a grant from the “Fondazione Del Monte di Bologna e Ravenna” and “Fondazione Cassa di Risparmio di Bologna” (Bologna, Italy).

Financial Disclosure: None to disclose.

Reprints: Umberto Volta, MD, Department of Clinical Medicine, Building 11, St. Orsola-Malpighi Hospital, Via Massarenti 9, 40138–Bologna, Italy (e-mail: umberto.volta@aosp.bo.it).

Received for publication July 3, 2009

accepted September 24, 2009

Conflicts: No conflict of interest exists.

The Authors wish to thank Mrs Susie Phillips for editing the manuscript.

© 2010 Lippincott Williams & Wilkins, Inc.