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Diagnostic Challenges of Celiac Disease


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Comparison of Serological Tests

Slide 6

June 2010

When we compare the different available serologic tests in terms of their sensitivity and specificity, as well as technical difficulty and cost, there are significant choices to be made. The top row is that of the human tissue transglutaminase antibodies. Generally speaking, the sensitivity is high and the specificity is reasonably high. The technical difficulty of this test is low. The endomysial antibody is an indirect immunofluorescence assay, which is a variable sensitivity that is somewhat interpreter and laboratory dependent. Its specificity is quite high, approaching 99% to 100%. Its technical difficulty is greater.

Gliadin IgA and gliadin IgG tests have been around for over 30 years. However, they are limited by quite variable sensitivity and often quite low specificity and, while they are simple to do, they are really not an appropriate test for screening for celiac disease. Their inclusion in panels for testing for celiac disease do not add much to sensitivity, but greatly detract from the specificity and, hence, are no longer recommended in most guidelines that address the detection of celiac disease.

A newer development in serologic testing for celiac disease involves the use of deamidated gliadin peptide antibodies. These tests are a substantial improvement over the earlier generation gliadin antibody tests and, at the Mayo Clinic, have replaced the earlier gliadin antibody tests as a choice for testing for celiac disease. Their sensitivity is perhaps a little less than that of tissue transglutaminase and their specificity is comparable. The combination of both tests probably adds to the sensitivity without substantially reducing the specificity.

Comparison of Serological Tests


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