Antibodies against human tissue transglutaminase and endomysium in diagnosing and monitoring coeliac disease

Scand J Gastroenterol. 2002 Jun;37(6):685-91. doi: 10.1080/00365520212496.


Background: Coeliac disease (CD) patients often present a variety of uncharacteristic symptoms and therefore sensitive and specific screening tests are needed as an aid in making an accurate diagnosis. A recently developed ELISA, using human recombinant tissue transglutaminase (tTG) as antigen, was evaluated for its significance in the diagnosis of CD. The patient's compliance to a gluten-free diet and the serological reaction during gluten challenge were also monitored. The results were compared with IgA-endomysium antibody (EMA) results.

Methods: Sera previously collected from 365 patients (0.4-76 years) with jejunal biopsy on a gluten-containing diet and from 41 patients on a gluten-free diet or challenge were tested for IgA anti-human tTG antibodies (IgA tTG ab) with Celikey (Pharmacia Diagnostics). The study population comprised 208 CD patients and 157 controls. The diagnostic performance and cut-off for the assay were estimated with ROC analysis. EMA was analysed by indirect immunofluorescence microscopy on cryostat sections of monkey oesophagus.

Results: 200/208 patients with CD had positive IgA tTG ab (median >100 U/ml), while only 1/157 of the control patients were positive (median 1.67 U/ml). The area under the ROC curve was 98.3% and the sensitivity and specificity of the test were 96% and 99% for the study population. Only 4/365 patients (1%) presented discordant IgA tTG ab and EMA results, 2 of them had only IgA tTG ab and 2 only EMA. The IgA tTG ab levels and the EMA titres were closely correlated to the duration of gluten-free diet and gluten challenge, respectively.

Conclusion: IgA tTG ab can be used as an accurate observer-independent alternative to EMA in diagnosing or monitoring CD.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Autoantibodies / analysis
  • Autoantibodies / immunology*
  • Case-Control Studies
  • Celiac Disease / blood
  • Celiac Disease / diagnosis*
  • Celiac Disease / therapy
  • Child
  • Child, Preschool
  • Diet
  • Enzyme-Linked Immunosorbent Assay*
  • Female
  • Fluorescent Antibody Technique, Indirect
  • Follow-Up Studies
  • Humans
  • Immunoglobulin A / analysis
  • Immunoglobulin A / immunology
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Probability
  • Prospective Studies
  • ROC Curve
  • Reference Values
  • Sensitivity and Specificity
  • Transglutaminases / analysis
  • Transglutaminases / immunology*


  • Autoantibodies
  • Immunoglobulin A
  • Transglutaminases