Reliance on serum endomysial antibody testing underestimates the true prevalence of coeliac disease by one fifth

Scand J Gastroenterol. 2000 Feb;35(2):181-3. doi: 10.1080/003655200750024362.


Background: Although IgA endomysial antibody (EmA) is currently the serologic test of choice in selecting suspected coeliac patients for duodenal biopsies, false-negative cases have been reported and may be more common than previous studies suggest. We assessed the sensitivity of EmA for patients with biopsy-confirmed villous atrophy (VA).

Methods: We studied 89 patients without IgA deficiency for whom biopsy had not been primarily prompted by a positive EmA result. VA was graded as partial, subtotal, or total (PVA, STVA, TVA). Serum EmA was assayed with indirect immunofluorescence.

Results: The sensitivity of EmA for VA was 78% (69 of 89) and was similar for PVA (79%) and ST/TVA (77%). Only 4 of the 20 EmA-negative patients had increased serum IgA-class antigliadin antibody levels as measured with enzyme-linked immunosorbent assay. All seronegative patients who complied with dietary gluten exclusion responded clinically, with histologic improvement after 12 months in 8 (67%) of 12 patients who had follow-up biopsies.

Conclusions: EmA-negative coeliac disease is common. Reliance on EmA testing to select patients for biopsy will result in significant underdiagnosis.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Autoantibodies / immunology*
  • Biopsy
  • Celiac Disease / diagnosis*
  • Celiac Disease / diet therapy
  • Celiac Disease / immunology
  • Female
  • Fluorescent Antibody Technique, Indirect
  • Gliadin / immunology*
  • Humans
  • IgA Deficiency
  • Immunoglobulin A / blood*
  • Male
  • Middle Aged
  • Muscle Fibers, Skeletal / immunology
  • Prevalence


  • Autoantibodies
  • Immunoglobulin A
  • Gliadin