Anti-endomysial antibody negative celiac disease: does additional serological testing help?

Dig Dis Sci. 2001 Jan;46(1):214-21. doi: 10.1023/a:1005589202529.


Anti-endomysium antibodies (AEM) fail to identify all untreated celiac disease (CD) patients. This study aims to determine if additional serology, in particular, IgA anti-tissue transglutaminase (tTG) antibodies, increases detection. Fifty-three biopsy-proven untreated CD patients (39 women, 14 men; median age 51 years) and 65 control patients with normal duodenal histology (46 women, 19 men; age range 17-90 years, median 45 years) were prospectively studied. Serum total IgA, IgA anti-tTG, IgA AEM, IgA anti-gliadin (AGA) and IgG AGA antibodies were measured. Thirteen (25%) CD patients were AEM negative. None were IgA deficient. Three AEM-negative CD patients had a raised IgA anti-tTG and IgA AGA. IgG AGA was raised in 10 AEM-negative CD patients, but also in 14/65 (22%) of controls. In conclusion, AEM-negative CD is common and detection is only modestly enhanced by testing for IgA anti-tTG antibodies. Duodenal biopsy is still recommended for the accurate diagnosis of CD.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies / blood*
  • Celiac Disease / diagnosis*
  • Female
  • Humans
  • Immunoglobulin A / blood*
  • Male
  • Middle Aged
  • Muscle Fibers, Skeletal / immunology*
  • Prospective Studies
  • Reticulin / immunology*
  • Serologic Tests*
  • Transglutaminases / immunology*


  • Antibodies
  • Immunoglobulin A
  • Reticulin
  • Transglutaminases