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Non-Invasive Diagnostic Tests for Celiac Disease

n the general population that is likely close to 1%.

The new serologic tests have altered the classic diagnostic pathway of CD in adults, which was based on clinical suspicion and duodenal biopsy. In 2004, the Agency for Healthcare Research and Quality issued a systematic review of the evidence regarding screening patients for CD. The results of that review indicate that tests for endomysial (EMA) and tissue transglutaminase (tTG) IgA autoantibodies have over 95 percent sensitivity, and close to 100 percent specificity, whereas biopsy with a strict cut-off requiring villous atrophy has high specificity, but poor sensitivity.

The question of who should be screened for CD remains controversial. Although it is well established that complications may develop in the absence of treatment, the natural history of undiagnosed celiac disease remains unclear. In addition, the need for a new gold standard for diagnosing CD in an era of advanced serologic testing has been recognized. For the present, the best epidemiologic approach to the diagnosis of CD may be a systematic process of case-finding in which patients with symptoms or typical or atypical conditions known to be associated with the disease are targeted.

Tests for tTG autoantibodies are easier to perform and less subjective and time-consuming than tests for autoantibodies to EMA. FDA-approved ELISA kits for detection of antibody are available from Bio-Rad Laboratories, Scimedx Corporation and IMMCO Diagnostics, Inc. The FDA has also approved a fluorescent-based microparticles immunoassay developed by Biomedical Diagnostics.

Even though the predictive value of anti-gliadin antibody (AGA) testing is not as strong as the tTG autoantibody tests, they still populate reference laboratory menus and are definitely worth mentioning. AGA testing is useful for testing pediatric populations and for individuals with IgA deficiency. Anti-gliadin antibody testing can also be used to monitor patients
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