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Autoimmune Gastrointestinal Dysmotility (AGID) Evaluation


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AGID Evaluation Testing Algorithm

Slide 12

January 2011

So now to look at this in the format of the testing algorithm, there are some antibodies that are always tested for and these are included in the box just below ‘always performed’. These are tested for using a variety of assays including immunofluorescence, ELISA and immunoprecipitation assays. There are four situations in which additional testing may be done and these are illustrated at the bottom of the screen. I will discuss these from left to right.

The first is the immunofluorescence pattern is indeterminate. In this situation there may be an antibody staining pattern suspicious for antineuronal nuclear antibody type-1, but not all of the characteristic features are present. In that setting we will additionally do a paraneoplastic Western blot to look for the characteristic Western blot pattern associated with this antibody.

The second setting and the third setting would occur where an antibody pattern suggestive of Amphiphysin antibody or CRMP-5 IgG were detected. Then we would confirm the presence of these antibodies with recombinant Western blots for the appropriate antibody, either Amphiphysin or CRMP-5 IgG. The final setting in which additional testing may be done would be where the acetylcholine receptor binding antibody or striational antibody were detected. For this, the possibility of an antibody profile supportive of thymoma would come to mind. This could be further explored by doing testing for the acetylcholine receptor modulating antibody and CRMP-5 IgG by Western blot.

AGID Evaluation Testing Algorithm

 


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