Isolated positive anti-gliadin immunoglobin-A antibody in children with gastrointestinal symptoms.

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The use of immunoglobulin G and A anti-gliadin antibodies for celiac disease screening has decreased due to higher specificity and sensitivity of tissue transglutaminase and endomysial antibodies . Greater values of immunoglobulin-A anti-gliadin antibody have been associated with more severe mucosal damage in proven and probable celiac disease patients . The aim of this study was to determine whether anti-gliadin antibody immunoglobulin A has any clinical importance in diagnosing celiac disease in children . Children with a chronic history of vomiting , abdominal pain , diarrhea , or constipation in the outpatient clinic were evaluated for celiac disease .Tissue transglutaminase and anti-gliadin antibody immunoglobulin A in serum were determined by ELISA test and endomysial antibodies immunoglobulin A by indirect immunofluorescence . Most of these children with isolated positive anti-gliadin antibody immunoglobulin A were further evaluated by performing proximal gastrointestinal biopsies .Sixteen children had isolated positive anti-gliadin antibody immunoglobulin A (negative tissue transglutaminase and endomysial antibodies immunoglobulin A ). Eight were male (mean age : 9 .7 years ). None had immunoglobulin A deficiency . Thirteen underwent an upper endoscopy with multiple small bowel biopsies . Two patients had villous atrophy and slightly increased intraepithelial lymphocytes (Marsh 3 a ), which could make the diagnosis of celiac disease likely . These two patients had high titers of anti-gliadin antibody immunoglobulin A above 70 Units .An isolated positive antigliadin antibody immunoglobulin A result in the absence of positive tissue transglutaminase and endomysial antibodies immunoglobulin A should raise the suspicion of the diagnosis of celiac disease . This could be a non-specific phenomenon that could be found in other gastrointestinal conditions , latent celiac disease , or gluten hypersensitivity . A longitudinal clinical follow-up is recommended in these children to confirm the diagnosis .