The reliability of noninvasive tests for celiac disease

Prevalence of celiac antibodies in children with neurologic disorders

Neurologic complications are a recognized but unusual manifestation of celiac disease (CD) in adults and children. The use of antigliadin and antiendomysial antibodies in screening has revealed the frequency of CD among symptom-free individuals to be high. Recently, a high frequency (57%) of antigliadin antibodies was demonstrated in adult patients with neurologic dysfunctions of unknown cause. We investigated the yield of screening for CD in children with common neurologic disorders. One hundred sixty-seven children, 1-16 years of age, were included in the study: 41 with migraine headaches, 39 with attention-deficit disorder with or without hyperactivity, 36 with epileptic disorders, and 51 with hypotonia and motor abnormalities. Positive IgG antigliadin antibodies were evident in 22 children (13%) in the study group compared with three children (9%) in the control group. However, in all children, negative IgA and endomysial antibodies were observed; thus duodenal biopsies were not performed. Contrary to studies performed in adults, these results did not demonstrate any relationship between common neurologic disorders without a specific diagnosis during childhood and CD. Thus screening for CD does not need to be routinely included in the diagnostic evaluation of children with these disorders.

Prevalence of IgA-antigliadin antibodies and IgA-antiendomysium antibodies related to celiac disease in children with Down syndrome

OBJECTIVE

This study was undertaken to investigate the prevalence of celiac disease in children and adolescents with Down syndrome.

MATERIAL AND METHODS

Forty-three children and adolescents with Down syndrome were screened for IgA-antigliadin antibodies (AGA) and IgA-antiendomysium antibodies (EMA). Patients found to be either AGA- or EMA-positive were investigated further with intestinal biopsy.

RESULTS

None of the 43 patients had known celiac disease at entry into the study; 37% (16/43) were found to have AGA levels above normal, and 16% (7/43) to be EMA-positive. Of the 15 patients who underwent biopsy, 8 manifested villous atrophy. Villous atrophy was present in all 7 of the EMA-positive patients, whereas the villi were normal in 7 of the 13 AGA-positive patients who underwent biopsy.

CONCLUSIONS

EMA is a good immunologic marker for use in screening for celiac disease, and screening is justified in patients with Down syndrome.

Recent developments in our understanding of adult coeliac disease

Coeliac disease, previously regarded as unusual and florid, is now seen as having an extraordinary breadth of manifestations. Many cases are unrecognised or latent. Diarrhoea and abdominal complaints may be present in low key but chronic ill health; anaemia, endocrine and neurological changes are increasingly recognised. Suspicion should lead straight to serological tests, of which the antiendomysial antibody test is best. If suspicion is high, endoscopic duodenal biopsy is mandatory. A gluten free diet, while difficult to maintain, effectively cures and prevents complications.