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Vol. 53. Issue 6.
Pages 533-541 (01 December 2000)
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Vol. 53. Issue 6.
Pages 533-541 (01 December 2000)
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Valor de los marcadores serológicos en el diagnóstico de la enfermedad celíaca. Propuesta de un protocolo
Value of serological markers in the diagnosis of celiac disease. a proposed guideline
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J.A. Garrote Adrados, E. Arranz Sanz, A. Blanco Quirós
Corresponding author
ablanco@ped.uva.es

Correspondencia: Facultad de Medicina. Área de Pediatría. Ramón y Cajal, 5. 47005 Valladolid
, P.P. Oyaguez Ugidos, C. Calvo Romero, A. Blanco del Val, M. Alonso Franch
Área de Pediatría. Facultad de Medicina y Hospital Clínico. Universidad de Valladolid
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Objetivo

La alta frecuencia de casos atípicos de enfermedad celíaca y de formas con pobre sintomatologia ha potenciado la búsqueda de marcadores analíticos que apoyen la indi-cación de la biopsia intestinal. Las pruebas más extendidas son la determinación de anticuerpos antigliadina de clase IgG e IgA (AAG-IgG y AAG-IgA) y antiendomisio (AEm-IgA).

Methods

Se presenta la experiencia de 10 años, estudiando AAG en 1.075 sueros de pacientes con enfermedad celíaca y AEm-IgA en 534. Los marcadores séricos se compararon a la biopsia intestinal en 152 casos en los que se realizaron simultáneamente

Resultados

En los casos con atrofia intestinal grave fue la alta sensibilidad de los AAG-IgG (91 %) y de los AEm-IgA (94%), quienes además mostraron el valor predictivo positivo (88%) y negativo (97%) más altos. Un título positivo de AEm-IgA coincidió con una biopsia alterada al 100 % de los casos. Los AEm-IgA fueron también el marcador más eficaz para el control de la dieta sin gluten. Sin embargo, en los casos con atrofia parcial de la mucosa intestinal ningún marcador fue lo bastante indicativo

Conclusiones

Los AEm-IgA son el mejor marcador serológico de enfermedad celíaca. A la luz de los resultados y según la prevalencia estimada de esta enfermedad, se proponen protocolos de utilización de los marcadores serológicos para el diagnóstico de los síndromes malabsortivos, para estudios de poblaciones de bajo y alto riesgo de enfermedad celíaca y para el seguimiento de los pacientes diagnosticados.

Palabras clave:
Enfermedad celíaca
Anticuerpos antigliadina
Anticuerpos antiendomisio IgA
Background

In recent years, the high frequency of atypical cases of celiac disease (CD) and of forms of this disease with minor symptoms has prompted the search for analytical markers that may support indications for intestinal biopsy. The commonest tests are those for serum class IgG and IgA antigliadin antibodies (IgG-AGA, IgA-AGA) and IgA anti-endomysial antibodies (IgA-EmA).

Methods

We report our 10-year experience of studying AGA in 1,075 serum samples from patients with CD and IgA-EmA in 534 samples. The serological markers were compared with 152 intestinal biopsies performed simultaneously with the other tests

Results

In patients with severe intestinal atrophy the sensitivity of IgA-AGA (91 %) and IgA-EmA (94 %) was high. IgA-EmA and the latter showed the highest positive (88 %) and negative (97 %) predictive values. In all patients, IgA-EmA positivity coincided with alterations in the biopsy. Determination of IgA-EmA was also the most efficient marker for monitoring the glutenfree diet phase. However, in patients in whom minimal histological changes were found in the intestinal mucosa, none of the markers was sufficiently accurate.

Conclusions

IgA-EmA antibodies are the most accurate serological marker of CD. In view of these results and the estimated prevalence of the disease, protocols for the use of serological markers are proposed for the differential diagnosis of malabsorption symptoms, for use in patients at low and high risk of CD and for the follow-up of those with a diagnosis of CD

Keywords:
Celiac disease
Antigliadin antibodies
Antiendomysial antibodies IgA
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