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#Serological testing chart 4 western blot results series

In practice, both tests have >85% sensitivity and >90% specificity. 11Ĭurrently, serologic testing for coeliac disease consists of the transglutaminase (tTG) and deamidated gliadin peptide (DGP) antibody tests. One-third of patients with coeliac disease are overweight or obese at diagnosis. Some patients have minimal or no obvious symptoms, or only extra‑intestinal issues. Clinical heterogeneity is substantial.Coeliac disease should not be excluded on the basis of a patient’s ethnicity or appearance. 10 Reports from Asian countries, such as China, are on the rise. Coeliac disease is a global disorder that is common in Western populations, North Africa, the Middle East, India and Pakistan.Men with coeliac disease are often overlooked. Coeliac disease affects both sexes, with a modest female predominance.The median age of diagnosis is 40 years, but do not discount coeliac disease in the young and elderly. Coeliac disease can develop at any age.A positive family history of coeliac disease carries the strongest predictive value for the disease. These non-classical features include lethargy, headaches, osteoporosis, iron deficiency, transaminase elevation, infertility, other autoimmune disease and dermatitis herpetiformis. 9 ‘Classical’ symptoms caused by intestinal inflammation, such as diarrhoea and weight loss, are frequent, but the ‘non-classical’, extra-intestinal manifestations are even more common. Symptoms and clinical features that identify patients who might benefit from testing are shown in Table 1. Recommended diagnostic pathway for coeliac diseaseĬD, coeliac disease DGP, deamidated gliadin peptide antibody tTG, tissue transglutaminase antibody When to test for coeliac disease Magnification ×100, haematoxylin and eosin stain.įigure 2. Untreated coeliac disease showing the classic triad of infiltration of the epithelium with lymphocytes, crypt hyperplasia and villous atrophy. Normal small intestinal mucosa in adequately treated coeliac disease.ī. Healthy small intestine, compared with villous atrophy in coeliac disease.Ī. 8 Figure 2 provides an outline of a recommended diagnostic pathway.įigure 1. 7 There is insufficient evidence to support population screening. Approximately 30 at-risk individuals need to be tested to find a positive case of coeliac disease. 3,6 An active case-finding approach can improve detection of coeliac disease by more than 40-fold, 7 but this only works when doctors are mindful of the disease. Testing at-risk individuals is strongly recommended to detect cases before substantial morbidity develops. Coeliac disease can be present despite negative coeliac disease serology, but this is uncommon and excluding other causes of villous atrophy (see below) is important. 3,6Ĭorrelation of histology and serology with clinical history is important. disease remission confirmed by symptom resolution, normalised coeliac disease serology and, most reliably and importantly, mucosal healing following treatment with a GFD.

intestinal histology showing raised intraepithelial lymphocytes (>25 per 100 enterocytes), crypt hyperplasia and villous atrophy (Figure 1).

In patients with positive coeliac disease serology, the diagnosis is confirmed by the presence of characteristic small intestinal mucosal changes. In clinical practice, suspected patients are generally screened with coeliac disease serology. 5 As expeditious diagnosis and treatment with a strict, lifelong gluten-free diet (GFD) minimises long-term complications, 3 application of the appropriate tests to ensure accurate diagnosis and follow-up is crucial. However, its broad and often subtle presentation makes detection challenging, and means 80% of Australians with coeliac disease remain undetected. 3 As 1.5% of Australians have coeliac disease, it is one of the most common autoimmune illnesses that general practitioners (GPs) will encounter. 2–4 Mortality is increased because of lymphoproliferative malignancy, sepsis and refractory disease. 1 Untreated disease reduces quality of life, increases healthcare use and is associated with substantial morbidity.

#Serological testing chart 4 western blot results series

Articles in this series aim to provide information about emerging laboratory tests that general practitioners may encounter.Ĭoeliac disease is an immune illness, triggered by dietary gluten, that causes a broad range of gastrointestinal and extra-intestinal manifestations. This article is the second in a series on pathology testing.