Hi!
What do you think of this?
Alice
http://bmj.bmjjournals.com/cgi/content/ ... 28.AEv1?ct
Detection of secretory IgA antibodies against gliadin and human tissue transglutaminase in stool to screen for coeliac disease in children: validation study
Matthias Kappler 1, Susanne Krauss-Etschmann 2, Veronika Diehl 1, Hannelore Zeilhofer 1, Sibylle Koletzko 1*
1 Division of Gastroenterology, Dr. v. Haunersches Kinderspital, Ludwig Maximilians University, Lindwurmstr 4, 80337 Munich, Germany
2 GSF National Center for Environment and Health, Clinical Cooperation Group Pediatric Immune Regulation, Munich
* Correspondence to: Sibylle.Koletzko{at}med.uni-muenchen.de.
Objective To evaluate two commercial stool tests for detection of secretory IgA antibodies against gliadin and human tissue transglutaminase for diagnosis of coeliac disease in children with symptoms.
Setting Tertiary care children's hospital.
Participants Coded stool samples from 20 children with newly diagnosed coeliac disease and 64 controls. Six children with coeliac disease had stool tests every two weeks for three months after starting a gluten-free diet.
Main outcome measures Secretory IgA antibodies against gliadin and human tissue transglutaminase in stool samples, determined in duplicate by using recommended cut-off limits.
Results Sensitivity of faecal antibodies against human tissue transglutaminase was 10% (95% confidence interval 1% to 32%), and specificity was 98% (91% to 100%). For antibodies against gliadin, sensitivity was 6% (0% to 29%) and specificity was 97% (89% to 100%). Optimisation of cut-off limits by receiver operating characteristic analysis and use of results of both tests increased sensitivity to 82%, but specificity decreased to 58%. All follow-up stool tests remained negative, except for two positive anti-gliadin results in one patient, six and 10 weeks after the gluten-free diet was started.
Conclusions Neither stool test was suitable for screening for coeliac disease in children with symptoms.
(Accepted 8 November 2005)
Polly - stool test validation study
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Hmmmmmmmmm. I'm obviously not Polly, but that's very interesting. I wish we knew whose commercial lab tests they were evaluating.
Wayne
Wayne
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hi Alice and tex,
I really can't draw much of a conclusion based upon the above info. It was a very small study and mentions nothing about its methods, which are critical to understanding the results. A huge difference could occur based on what the researchers used as a cut-off point to determine positivity. IOW, given that these kiddies had actual CD, they may have been looking for much higher numbers of antibodies. Thanks for sharing.........it's interesting and a good sign that these issues are being studied.
Love,
Polly
I really can't draw much of a conclusion based upon the above info. It was a very small study and mentions nothing about its methods, which are critical to understanding the results. A huge difference could occur based on what the researchers used as a cut-off point to determine positivity. IOW, given that these kiddies had actual CD, they may have been looking for much higher numbers of antibodies. Thanks for sharing.........it's interesting and a good sign that these issues are being studied.
Love,
Polly
Blessed are they who can laugh at themselves, for they shall never cease to be amused.
Hmm, and they never mentioned whether or not they used the so-called "Gold Standard" tests to make the diagnoses. This would be important to know.
With the type of "celiac lite" that we have with M.C.,, people frequently have negative results from the blood tests for these antibodies, yet they know they react strongly to even the most minute amounts of gluten, so this leads me to believe that the methodology is different, and we pretty well have already established that celiac lite is different from celiac disease anyway, but somehow this just match up with our experience with M.C., does it?
I've already forgotten how they did that test in Italy that validated the stool testing that they do over there. Do you suppose their testing wasn't used in this study?
Yours, Luce
With the type of "celiac lite" that we have with M.C.,, people frequently have negative results from the blood tests for these antibodies, yet they know they react strongly to even the most minute amounts of gluten, so this leads me to believe that the methodology is different, and we pretty well have already established that celiac lite is different from celiac disease anyway, but somehow this just match up with our experience with M.C., does it?
I've already forgotten how they did that test in Italy that validated the stool testing that they do over there. Do you suppose their testing wasn't used in this study?
Yours, Luce
Also, this would imply that lots of gluten sensitivity wouldn't be picked up in celiacs, but Dr. Fine's test for gluten antibodies picks up gluten sensitivity frequently in those of us with M.C., so it has to be sensitive to pick it up in such a high percentage. That's what leads me to believe they're not using the best tests/most sensitive tests, in other words.
On the other hand, I just remember a few of us having the tTg antibodies in our stools.
I was one of them, but then I also have the main gene for celiac disease, sooo...
Something here just doesn't compute, and yet, it's a small study.
Alice, keep us updated about the celiac site information, please.
Yours, Luce
On the other hand, I just remember a few of us having the tTg antibodies in our stools.
I was one of them, but then I also have the main gene for celiac disease, sooo...
Something here just doesn't compute, and yet, it's a small study.
Alice, keep us updated about the celiac site information, please.
Yours, Luce