Coeliac disease case finding and diet monitoring by point-of-care testing

Aliment Pharmacol Ther. 2005 Oct 15;22(8):729-37. doi: 10.1111/j.1365-2036.2005.02663.x.

Abstract

Background: Immunoglobulin A class transglutaminase autoantibodies are highly predictive markers of active coeliac disease, a disorder difficult to recognize solely on clinical grounds.

Aims: To develop and evaluate a simple rapid test for point-of-care detection of coeliac autoantibodies.

Methods: The novel whole blood test utilizes the patient's endogenous transglutaminase in red blood cells for detection of transglutaminase-specific immunoglobulin A antibodies present in the blood sample, with normal plasma immunoglobulin A detection as positive test control. We evaluated 284 patients under suspicion of coeliac disease and undergoing jejunal biopsy, and 263 coeliac patients on a gluten-free diet, 383 being tested prospectively in a point-of-care setting. Results were compared with histology, conventional serum autoantibody results and dietary adherence.

Results: The rapid test showed 97% sensitivity and 97% specificity for untreated coeliac disease, and identified all immunoglobulin A-deficient samples. Point-of-care testing found new coeliac cases as efficiently as antibody tests in laboratory. Coeliac autoantibodies were detected onsite in 21% of treated patients, while endomysial and transglutaminase antibodies were positive in 20% and 19%, respectively. The positivity rate correlated with dietary lapses and decreased on intensified dietary advice given upon positive point-of-care test results.

Conclusions: Point-of-care testing was accurate in finding new coeliac cases and helped to identify and decrease dietary non-compliance.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Autoantibodies / blood
  • Celiac Disease / diagnosis*
  • Celiac Disease / diet therapy*
  • Child
  • Child, Preschool
  • Glutens / administration & dosage
  • Humans
  • Immunoassay / instrumentation
  • Immunoassay / methods
  • Immunoglobulin A / blood
  • Infant
  • Middle Aged
  • Patient Compliance
  • Point-of-Care Systems
  • Prospective Studies
  • Reagent Kits, Diagnostic
  • Sensitivity and Specificity
  • Transglutaminases / immunology

Substances

  • Autoantibodies
  • Immunoglobulin A
  • Reagent Kits, Diagnostic
  • Glutens
  • Transglutaminases