Serum IgA antiendomysium antibody titers as a marker of intestinal involvement and diet compliance in adult celiac sprue

J Clin Gastroenterol. 1993 Sep;17(2):123-7. doi: 10.1097/00004836-199309000-00007.


IgA-class antiendomysium antibodies (IgA-EmAs) are a very sensitive and specific serological marker of celiac sprue. Using an indirect immunofluorescent method, we evaluated the kinetics of the antibody titers both during a gluten-free diet and after gluten was added, comparing them with the intestinal histological pattern. The IgA-EmA titers were evaluated on sera from 91 untreated adults with biopsy-proven celiac sprue and, when positive, were reappraised after different durations of gluten-free diet. Antibody titers were also retested in eight adolescents who had voluntarily discontinued the diet while they were on a free diet. The IgA-EmAs were detectable in 85 of 91 (93.40%) patients but in none of the 438 controls (100% specificity). The antibody titers ranged from 1:5 to 1:2,000 or more and the intestinal histopathological pattern paralleled the antibody titers. After gluten withdrawal, IgA-EmA titers declined to zero in all patients complying with their diet. Modifications in gut histopathologic condition paralleled IgA-EmA kinetics, although seroconversion to negativity preceded mucosal recovery. After a gluten rechallenge, deterioration in gut histopathologic condition followed EmA reversion to positivity. Three negative IgA-EmA tests did not reflect a worsening in gut histopathologic condition after a gluten-containing diet, thus making the diagnosis of celiac sprue uncertain.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Autoantibodies / blood*
  • Biomarkers / blood
  • Celiac Disease / diet therapy*
  • Celiac Disease / immunology*
  • Celiac Disease / pathology
  • Dietary Proteins / administration & dosage
  • Female
  • Glutens / administration & dosage
  • Humans
  • Immunoglobulin A / blood*
  • Intestine, Small / pathology
  • Male
  • Middle Aged
  • Muscle, Smooth / immunology*
  • Patient Compliance*
  • Predictive Value of Tests
  • Sensitivity and Specificity


  • Autoantibodies
  • Biomarkers
  • Dietary Proteins
  • Immunoglobulin A
  • Glutens