The significance of the determination of antigliadin and endomysial antibodies in the diagnostics of celiac disease

Celiac disease is a chronic, immunologically mediated disease of the small intestinal mucosa clinically characterized by malabsorption due to permanent gluten intolerance. Gluten is a protein found in wheat, rye, and barley consisting of peptid fraction gliadin and glutenin. Of these two, gliadin is a toxic factor responsible for damage to the intestinal mucosa in children. According to previous ESPGAN diagnostic criteria, at least three small bowel biopses were required for accurate diagnosis of the celiac disease (an initial one during the acute phase of the disease, the second following at least two years of gluten-free diet, and the third after return to a gluten-containing diet). Recent studies showed that the sera of celiac patients contain antigliadin IgA and IgG as well as antiendomysium IgA antibodies, their titers highly positively correlating with the biopsy results in all clinical stages of the disease, but only if determined simultaneously. The aim of this study was to validate the application of serological tests in diagnostics and the follow-up of celiac disease in children less than 3 years old. The study includes a total of 138 children in various clinical stages of the disease (acute phase, remission during gluten-free diet and relapse after the return to a gluten-containing diet). In the sera of all the children antigliadin antibodies of IgA and IgG class as well as antiendomysium antibody of IgA class were determined. The serological methods applied were validated on the basis of their sensitivity, specificity and positive and negative prediction. Biopsy findings of the small intestinal mucosa of the same patients were taken as the basis for statistical evaluation.The results of the study showed that the serological methods applied are objectively valid and differential to such an extent that their introduction to the routine clinical protocol of establishing and monitoring of celiac disease in adolescents is more than justified.