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Our aim was to assess differences in the sensitivities of serologic tests used for the diagnosis of celiac disease among patients with varying degrees of villous atrophy. Among 115 adults with biopsy-proven celiac disease who fulfilled strict criteria,including serologic testing at the time of diagnosis and response to a gluten-free diet, 71% had total villous atrophy and 29% partialvillous atrophy. Endomysial antibody was positive in 77% of thosewith total villous atrophy, compared to 33% with partialvillous atrophy (P< 0.001). There was no difference in sensitivity when the type of presentation (classical vs.silent) was compared. Endomysial antibodypositive and negative patients did not differ with respect to age at diagnosis, duration of symptoms,mode of presentation, or family history of celiac disease.All anti-tissue transglutaminasepositive patients had TVA on biopsy. Seronegative celiac disease occurs. Endomysial antibody positivity correlates with more severe villous atrophy and not mode of presentation of celiac disease. Serologic tests, in clinical practice, lack the sensitivity reported in the literature.
Our aim was to assess differences in the sensitivities of serologic tests used for the diagnosis of celiac disease among patients with varying degrees of villous atrophy. Among 115 adults with biopsy-proven celiac disease who fulfilled strict criteria, including serologic testing at the time of diagnosis and response to a gluten-free diet, 71% had total villous atrophy and 29% partialvillous atrophy. Endomysial antibody was positive in 77% of those with total villous atrophy, compared to 33% with partialvillous atrophy (P <0.001). There was no difference in sensitivity when the type of presentation (classical vs. silent) was compared. Endomysial antibodypositive and negative patients did not differ with respect to age at diagnosis, duration of symptoms, mode of presentation, or family history of celiac disease. All- tissue transglutaminasepositive patients had TVA on biopsy. Seronegative celiac disease occurs. Endomysial antibody positivity correlates with more severe villous atrophy an d not mode of presentation of celiac disease. Serologic tests, in clinical practice, lack the sensitivity reported in the literature.