Point-of-Care Test in Adult Case-Finding in Celiac Disease
Point-of-Care Test in Adult Case-Finding in Celiac Disease
In total, 12 out of 148 (8%) first-degree healthy relatives showed positivity in the POCT. All POCT-positive subjects proved to be EMA-positive, giving 100% specificity for the POCT against the reference standard for serum CD autoantibody. Only one more positive subject was found by the EMA test (Table 1) and all the remaining 135 healthy first-degree relatives were negative both in the POCT and for EMA.
Altogether 10/13 antibody positive family members were adults (median age 38.5 years). Four subjects positive for both POCT and EMA were negative for TG2-IgA when using the manufacturer's positivity cut-off of 5 U/ml. When again using 3 U/ml as cut-off, as suggested by the new ESPGHAN 2012 criteria, only one EMA-positive subject would have been missed by the ELISA method. Her EMA titre was low, 1:5, but she was also POCT-positive (case 4 in Table 1). The only EMA-positive subject, case 7 in Table 1, with a low serum titer of 1:50 and yielding a negative test result in POCT, had a TG2-IgA titer of 4.2 U/ml.
Ten of the thirteen antibody-positive first-degree relatives agreed to undergo upper gastrointestinal endoscopy and duodenal biopsies. All but one showed coeliac-type mucosal lesions of grade Marsh 2 (n = 3) and Marsh 3 (n = 6), as summarized in Table 1. POCT was found to be positive in eight of the nine subjects with biopsy-proven CD. The three POCT-positive subjects not agreeing to undergo endoscopy also showed marked positivity in both EMA and TG2-IgA tests (Table 1). The prevalence of coeliac gluten sensitivity was 8.7% as determined by positive autoantibodies.
Results
In total, 12 out of 148 (8%) first-degree healthy relatives showed positivity in the POCT. All POCT-positive subjects proved to be EMA-positive, giving 100% specificity for the POCT against the reference standard for serum CD autoantibody. Only one more positive subject was found by the EMA test (Table 1) and all the remaining 135 healthy first-degree relatives were negative both in the POCT and for EMA.
Altogether 10/13 antibody positive family members were adults (median age 38.5 years). Four subjects positive for both POCT and EMA were negative for TG2-IgA when using the manufacturer's positivity cut-off of 5 U/ml. When again using 3 U/ml as cut-off, as suggested by the new ESPGHAN 2012 criteria, only one EMA-positive subject would have been missed by the ELISA method. Her EMA titre was low, 1:5, but she was also POCT-positive (case 4 in Table 1). The only EMA-positive subject, case 7 in Table 1, with a low serum titer of 1:50 and yielding a negative test result in POCT, had a TG2-IgA titer of 4.2 U/ml.
Ten of the thirteen antibody-positive first-degree relatives agreed to undergo upper gastrointestinal endoscopy and duodenal biopsies. All but one showed coeliac-type mucosal lesions of grade Marsh 2 (n = 3) and Marsh 3 (n = 6), as summarized in Table 1. POCT was found to be positive in eight of the nine subjects with biopsy-proven CD. The three POCT-positive subjects not agreeing to undergo endoscopy also showed marked positivity in both EMA and TG2-IgA tests (Table 1). The prevalence of coeliac gluten sensitivity was 8.7% as determined by positive autoantibodies.
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