Use of the Anti-Endomysial Antibody test to Diagnose Coeliac Disease in Clinical Practice
Pearce, C.B.; Sinclair, D.; Duncan, H.D.; Saas, M.; Poller, D.N.
Clinical Laboratory 48(5-6): 313-311
2002
ISSN/ISBN: 1433-6510 PMID: 12071583 Document Number: 8023
Background: Guidelines suggest that duodenal biopsies should be taken in patients with iron deficiency anaemia. Objective: To examine anti-endomysial antibody (anti-EMA) and duodenal biopsy testing in Portsmouth, UK. To evaluate if the current pathology workload can be reduced by anti-EMA replacing some duodenal biopsies. To determine to what extent doctors in Portsmouth are confÏrming a positive anti-EMA test by small bowel biopsy. Design: Patients' records were examined firstly from whom duodenal biopsies were taken between April 1999 and September 2000, and secondly who had anti-EMA tested between December 1999 and September 2000. Setting: Queen Alexandra Hospital, UK. District General Hospital. Medical Outpatients Department. Results: In the first group, of 354 patients undergoing duodenal biopsy, 108 patients had anti-EMA tested. Of these 108 patients, 25 had positive IgA anti-EMA and 83 had negative IgA anti-EMA. Of these 83 patients who had negative IgA EMA, 8 patients had a duodenal biopsy suggestive of Coeliac Disease. 4 of these 8 patients were on gluten free diets at the time of anti-BMA testing so were excluded. 1 of the 4 patients who had a duodenal biopsy indicative of Coeliac Disease had a positive IgG anti-EMA despite negative IgA anti-EMA. Therefore 3 false negative IgG anti-EMA were ultimately identified giving a sensitivity of 89% and a specificity of 100%. On follow up one has subsequently been found to have T-cell lymphoma; if this patient is taken into account the sensitivity of anti-EMA increases to 93%. In the second group; 1450 patients had anti-EMA tested. Of the 67 positive anti-EMA tests in this group only 12 had a duodenal biopsy. Conclusions: Many patients who have been tested for anti-EMA are not offered duodenal biopsy in Portsmouth despite current British Society of Gastroenterology (BSG) guidelines, although it should be noted that the BSG guidelines on iron-deficiency anaemia recommend using anti-EMA without histology to exclude Coeliac Disease in menstruating women (biopsy would still be recommended if anti-EMA were positive). Our study has found a high sensitivity and specifïcity of anti-EMA; there may therefore be some circumstances where duodenal biopsy is unnecessary in the investigation of Coeliac Disease. Patients with suspected Coeliac Disease and negative anti-EMA should be evaluated for other causes of villous atrophy. (Clin. Lab. 2002;48:319-325) DOI: Clin. Lab. 2002;48:319-325
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