PMID- 25244521
OWN - NLM
STAT- MEDLINE
DCOM- 20150709
LR  - 20141124
IS  - 1549-781X (Electronic)
IS  - 1040-8363 (Linking)
VI  - 51
IP  - 6
DP  - 2014 Dec
TI  - Digesting all the options: laboratory testing for celiac disease.
PG  - 358-78
LID - 10.3109/10408363.2014.958813 [doi]
AB  - Celiac disease is a complex immune-mediated disorder that is triggered by 
      ingestion of gluten and related proteins in genetically susceptible individuals. 
      Under conditions of increased intestinal permeability, gluten-derived peptides 
      can travel across the intestinal epithelium and undergo deamidation catalyzed by 
      the tissue transglutaminase (TTG) enzyme. This renders them immunogenic in 
      individuals expressing specific human leukocyte antigen (HLA) DQ heterodimers. 
      The resulting immune response is characterized by the production of antibodies 
      against both deamidated gliadin peptides (DGP) and TTG, generation of 
      pro-inflammatory cytokines and activation of cytotoxic T cells. This response 
      damages the intestinal epithelium resulting in the wide range of gastrointestinal 
      and systemic symptoms observed in those with celiac disease. Celiac disease 
      diagnosis has traditionally been based on biopsy and histological examination of 
      the small intestine. While this approach is still considered the gold standard, 
      it is invasive and susceptible to both false-positive and false-negative results. 
      Several laboratory tests have become available to aid in the diagnosis and 
      monitoring of celiac disease, and are the focus of this review. These include 
      serological tests for celiac disease-specific antibodies such as anti-endomysial 
      antibodies, anti-TTG antibodies and anti-DGP antibodies of both the 
      immunoglobulin A (IgA) and immunoglobulin G (IgG) class, genetic tests to 
      elucidate HLA DQ status and ancillary tests such as total IgA. While some have 
      suggested that laboratory tests may replace intestinal biopsy in specific 
      circumstances, others maintain that this procedure remains a critical component 
      of celiac disease diagnosis. We review the analytical methodology, strengths, 
      weaknesses, diagnostic performance and clinical utility of the various laboratory 
      tests for celiac disease. Potential future markers and tests that are now 
      considered obsolete are also discussed. Current clinical practice guidelines for 
      the diagnosis and management of celiac disease from the European Society for 
      Pediatric Gastroenterology, Hepatology and Nutrition, the American College of 
      Gastroenterology and the World Gastroenterology Organisation are summarized, and 
      important differences between these guidelines are highlighted.
FAU - Barakauskas, Vilte E
AU  - Barakauskas VE
AD  - DynaLIFEDx , Edmonton, Alberta , Canada and.
FAU - Lam, Grace Y
AU  - Lam GY
FAU - Estey, Mathew P
AU  - Estey MP
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20140922
PL  - England
TA  - Crit Rev Clin Lab Sci
JT  - Critical reviews in clinical laboratory sciences
JID - 8914816
SB  - IM
MH  - Adult
MH  - Biopsy
MH  - Celiac Disease/*diagnosis/immunology/pathology/physiopathology
MH  - Child
MH  - Humans
MH  - Models, Biological
OTO - NOTNLM
OT  - Biopsy
OT  - deamidated gliadin peptide
OT  - endomysial antibody
OT  - gliadin
OT  - gluten
OT  - human leukocyte antigen DQ2 and DQ8
OT  - serology
OT  - tissue transglutaminase
EDAT- 2014/09/23 06:00
MHDA- 2015/07/15 06:00
CRDT- 2014/09/23 06:00
PHST- 2014/09/23 06:00 [entrez]
PHST- 2014/09/23 06:00 [pubmed]
PHST- 2015/07/15 06:00 [medline]
AID - 10.3109/10408363.2014.958813 [doi]
PST - ppublish
SO  - Crit Rev Clin Lab Sci. 2014 Dec;51(6):358-78. doi: 10.3109/10408363.2014.958813. 
      Epub 2014 Sep 22.