Objective: Assays for antibodies against native gliadin (anti-nGli) are still often assumed to perform better in the diagnosis of coeliac disease in young children than tests for antibodies to deamidated gliadin (anti-dGli), tissue transglutaminase (anti-tTG), and endomysium (EmA). We compared the performance of assays for anti-nGli, anti-dGli, anti-tTG, and EmA in this age group.
Methods: We investigated retrospectively 184 children (42 with coeliac disease under normal diet and 142 controls) up to 2 years of age. Immunoglobulin (Ig) A- and IgG-anti-dGli, IgA- and IgG-anti-nGli, IgA- and IgG-anti-tTG, and IgA-EmA were measured in serum. Areas under receiver operating characteristics curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, as well as diagnostic odds ratios were calculated.
Results: From all of the tests investigated, only assays for IgG-anti-dGli, IgA-anti-tTG, and IgA-EmA had high specificity (≥0.96) connected with high sensitivity (≥0.86), with high positive predictive values (≥0.52 and ≥0.69 at pretest probabilities of 0.05 and 0.1, respectively) and negative predictive values (≥0.99 and ≥0.98 at pretest probabilities of 0.05 and 0.1, respectively). These assays also showed high positive likelihood ratio (≥24) at low negative likelihood ratio (≤0.15) and high diagnostic odds ratios (≥136).
Conclusions: Our results do not support the use of assays of anti-nGli to diagnose coeliac disease in young children. IgA-anti-tTG, IgA-EmA, and IgG-anti-dGli perform better than anti-nGli.
*Children's Hospital of the Clinical Centre, “Sankt Georg,” Leipzig, Germany
†Department Laboratory Medicine of University Hospital, Leuven, Belgium
‡University Children's Hospital, Leipzig, Germany
§University Children's Hospital, Tübingen, Germany
||University Children's Hospital, Graz, Austria
¶University Children's Hospital, Giessen, Germany
#Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
**EUROIMMUN Medizinische Labordiagnostika GmbH, Lübeck, Germany
††Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Leipzig, Germany.
Address correspondence and reprint requests to Prof Dr Thomas Mothes, Department of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Liebigstrasse 27, D-04103, Leipzig, Germany (e-mail: firstname.lastname@example.org).
Received 12 September, 2011
Accepted 13 December, 2011
H.H.U. was supported by the German Coeliac Society. Sibylle Koletzko (University Children‘s Hospital, München, Germany) contributed patient samples and provided critical intellectual input. T.M., H.H.U, and C.D. submitted patents on methods for CD diagnosis (T.M., A.O., H.H.U., T.G., A.D.: “Peptide und Verfahren zur Diagnostik von Zöliakie und Dermatitis herpetiformis,” and C.P., C.D., W.S., W.S., L.K., T.M.: “Verfahren und Immunabsorbentien zur spezifischen Detektion und Absorption Zöliakie- und Dermatitis herpetiformis assoziierter Antikörper”).
The authors report no conflicts of interest.