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Celiac Disease Comprehensive Panel

Celiac Disease Comprehensive Panel

Test Highlight

Celiac Disease Comprehensive Panel

  

Clinical Use

  • Diagnose celiac disease in patients 4 years of age and older

Clinical Background

Celiac disease (CD) is caused by an immune response to gluten in genetically susceptible individuals. Patients may develop partial to complete villous atrophy of the small intestine, crypt hyperplasia, and lymphocytic infiltration of the epithelium and lamina propria. CD is more common than once thought, affecting approximately 1 in 100 Americans in the general population.1 The prevalence is even higher in individuals with insulin-dependent diabetes mellitus; autoimmune thyroiditis; Down, Turner, or Williams syndrome; selective IgA deficiency; unexplained iron deficiency anemia; premature-onset osteoporosis; or a family history of CD (first-degree relative).1,2 Early diagnosis of CD and initiation of a gluten-free diet are necessary to begin histologic improvement, which is more rapid and more complete in children than in adults.1

Presenting symptoms of CD vary according to age group and the extent of villous atrophy. Infants and young children commonly present with diarrhea, failure to thrive, and abdominal pain and distention. Older children and adolescents may exhibit extraintestinal symptoms including short stature, delayed puberty, anemia, and neurological symptoms caused by nutrient malabsorption. In up to 50% of adults with CD, diarrhea, which may be accompanied by abdominal pain or discomfort, is the presenting symptom. On the other hand, patients with CD may be asymptomatic, especially those in high-risk groups.

Diagnosis is based on biopsy of the small intestine, but serologic assays help identify patients who require this invasive procedure. Tissue transglutaminase antibody (tTG; IgA) is an excellent first-line marker, with high sensitivity (90% to 96%) and specificity (>95%) reported for children and adults with CD.1 Although this panel tests for endomysial antibody (EMA; IgA) only when tTG IgA results are positive, EMA testing can be ordered separately if the anti-tTG result is negative but clinical suspicion remains high. The antigliadin antibody tests (IgA and IgG) are no longer recommended in adults.3 Total serum IgA is measured to identify selective IgA deficiency, present in about 2% to 10% of CD patients. Such patients would have negative results on IgA anti-tTG and EMA assays but may have positive IgG anti-tTG results.

Because levels of anti-tTG and EMA tend to wane in the absence of gluten ingestion, these markers are useful to monitor adherence to a gluten-free diet. Testing frequencies of every 6 months after starting the gluten-free diet and 1 year in asymptomatic individuals have been recommended.2 Testing can also be performed at any time in individuals with persistent or recurrent symptoms.2 Tests available include Tissue Transglutaminase Antibody (IgA) (test code 8821) and Endomysial Antibody Screen (IgA) with Reflex to Titer (test code 15064).

Method

This panel includes a test for tTG IgA antibodies (enzyme-linked immunosorbent assay [ELISA]) and total IgA concentration (immunoturbidometry). When the tTG IgA test is positive, an EMA IgA antibody test is performed (immunofluorescence assay); if positive, the EMA titer will be determined and reported. If the IgA concentration is low, a tTG IgG antibody test will be performed (ELISA). There is an additional charge, associated with an additional CPT code, for the latter 3 tests (EMA IgA, EMA titer, and tTG IgG).

References

  1. Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) Institute technical review
    on the diagnosis and management of celiac disease. Gastroenterology. 2006;131:1981-2002.

  2. Hill ID, Dirks MH, Liptak GS, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
    J Pediatr Gastroenterol Nutr
    . 2005;40:1-19.

  3. NIH Consensus Statement on Celiac Disease. http://consensus.nih.gov/2004/2004CeliacDisease118main.htm. Published June 2004. Accessed December 10, 2012.
     

Content reviewed 12/2012

 
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