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This Article Full Text Full Text (PDF) 090308.Supplemental Data All Versions of this Article: clinchem.2007.090308v1 53/10/1775    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McGowan, K. E. Articles by Butzner, J. D. Search for Related Content PubMed PubMed Citation Articles by McGowan, K. E. Articles by Butzner, J. D. Related Collections Clinical Immunology Nutrition Evidence Based Laboratory Medicine and Test Utilization Proteomics and Protein Markers

Celiac Disease: Are Endomysial Antibody Test Results Being Used Appropriately?

Departments of¹ Pediatrics and ² Pathology and Laboratory Medicine and ³ Calgary Laboratory Services, University of Calgary, Calgary, Alberta, Canada.

^aAddress correspondence to this author at: Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta, Canada. Fax 403-955-2922; e-mail butzner{at}ucalgary.ca.

Background: The aim of this study was to retrospectively examine how positive IgA-endomysial antibody (EMA) test results for celiac disease were being interpreted and acted on by physicians in the Calgary Health Region.

Methods: We reviewed consecutive EMA test results, with or without a serum IgA, obtained during a 17-month period. Seropositive tests were cross-referenced to the surgical database to determine the number of patients who underwent intestinal biopsy and the results of the biopsy. We sent questionnaires to the ordering physicians of positive tests with no record of intestinal biopsy.

Results: Among 11 716 EMA tests in 9533 patients, 349 results were positive in 313 patients (3%). Intestinal biopsies were performed in 218 (70%) of the seropositive patients; 194 of them were diagnostic of celiac disease. Celiac disease was also found in 10 EMA-negative patients. Of the 109 positive tests performed in 95 patients with no subsequent biopsy, 28 had appropriate indications to not perform a biopsy; the most common reason being that the test had been ordered to follow up on a previous biopsy-proven diagnosis of celiac disease (n = 21). For 33 other positive test results without a subsequent biopsy, management appeared to be inappropriate, most commonly (n = 21) because of a recommendation to follow a gluten-free diet despite lack of a tissue diagnosis of celiac disease. For the remaining 48 positive EMA results, administrative issues prevented evaluation (n = 19), the patients refused further evaluation (n = 11), or physician surveys were not returned (n = 18).

Conclusions: Celiac disease affected 2% of patients, with a similar prevalence in male and female patients. Most positive EMA tests (77%) were appropriately managed by physicians. Beginning a gluten-free diet without biopsy or failing to follow up on a positive EMA test remain common errors of management.

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				M. Parizade, Y. Bujanover, B. Weiss, V. Nachmias, and B. Shainberg Performance of Serology Assays for Diagnosing Celiac Disease in a Clinical Setting Clin. Vaccine Immunol., November 1, 2009; 16(11): 1576 - 1582. [Abstract] [Full Text] [PDF]

				K. E. McGowan, M. E. Lyon, and J. D. Butzner Celiac Disease and IgA Deficiency: Complications of Serological Testing Approaches Encountered in the Clinic Clin. Chem., July 1, 2008; 54(7): 1203 - 1209. [Abstract] [Full Text] [PDF]