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Diagnostic Testing Algorithms for Celiac Disease



June 2010

Beyond Hot Topic is an opportunity for viewers to ask questions of the Hot Topic presenter.

For this Beyond Hot Topic, a conference call was held June 22, 2010 at 3:00pm CST. The questions presented below are unedited.

Transcript

Good afternoon and welcome to Mayo Medical Laboratories’ Beyond Hot Topic. Our program today is a follow-up to the Hot Topic “Diagnostic Testing Algorithms for Celiac Disease” and the Clinical Insight Hot Topic “Diagnostic Challenges of Celiac Disease.” Our presenters are Dr. Melissa Snyder and Dr. Joseph Murray. Dr. Snyder is Director of the Antibody Immunology Laboratory, in the Division of Clinical Biochemistry and Immunology at Mayo Clinic. Dr. Murray is a practicing gastroenterologist and Professor of Medicine and Immunology at Mayo Clinic, as well as Director of Mayo’s Celiac Disease Program.

  1. Sometimes our technologists see a borderline positive tTG and EMA neg and wonder which one is more accurate as a screen test. As you know the EMA-IFA is technologist-driven by expertise and technique, and may suffer as such in terms of inter-tech reproducibility. Whereas the tTG is an automated assay that potentially has better reproducibility. What are your thoughts on this?

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  2. Do patients who have tested negative need to be retested again?

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  3. What is the role for testing of family members of patients diagnosed with celiac disease?

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  4. What is the most appropriate test for screening for celiac disease in adults? What about in children?

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  5. In what clinical settings is HLA typing for celiac disease most appropriate?

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  6. What is the sensitivity and specificity of IgG tTG testing in IgA-deficient celiacs, as well as the sensitivity and specificity in non-IgA-deficient celiacs?

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  7. Do you have to stop doing anti-endomysial testing?

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  8. Is a biopsy necessary even if the tTG is very strongly positive, say 5 times the upper limit of normal or above?

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