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Antibody levels in adult patients with coeliac disease during gluten free diet a rapid initial decrease of clinical importance
Linköping University, Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology . Linköping University, Faculty of Health Sciences.
Department of Clinical Microbiology and Immunology, Örebro University Hospital, Örebro.
Department of Clinical Microbiology and Immunology, Örebro University Hospital, Örebro.
Department of Medicine, Örebro University Hospital, Örebro.
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2004 (English)In: Journal of Internal Medicine, ISSN 0954-6820 (print), 1365-2796 (online), Vol. 256, no 6, 519-524 p.Article in journal (Refereed) Published
Abstract [en]

Objective. Analysis of antibodies against tissue transglutaminase (tTG) has been shown valuable in the diagnosis of coeliac disease (CD) but how quickly serum titres decrease after introduction of a gluten-free diet (GFD) is not known in adults. CD is a well-recognized disorder amongst the general population and many persons try a GFD for fairly vague symptoms before they seek medical advice. Therefore, it is important to determine the time that the serologic tests remain predictive of the disease after the introduction of a GFD.

Methods. Sera were taken from 22 consecutively biopsy-proven adult patients with CD in connection with the diagnostic biopsy. The patients were followed for 1 year and sera were taken after 1, 3, 6 and 12 months after start of a GFD. Sera were stored at −20 °C and analysed for IgA antibodies against gliadin, endomysium and two different commercial tTG assays based on recombinant human tTG (tTGrh) and guinea-pig liver (tTGgp).

Results. Twenty patients could be followed during GFD and all antibody titres fell sharply within 1 month after introduction of a GFD and continued to decline during the survey interval. Thirty days after beginning the diet only 58, 84, 74 and 53% of all patients had positive antibody levels of tTGrh, tTGgp, EmA and AGA respectively.

Conclusions. As the antibodies used to confirm the diagnosis of CD fall rapidly and continue to decline following the introduction of a GFD, it is important that health care providers carefully inquire about the possibility of self-prescribed diets before patients sought medical attention.

Place, publisher, year, edition, pages
2004. Vol. 256, no 6, 519-524 p.
Keyword [en]
antibody response, coeliac disease, diet
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13987DOI: 10.1111/j.1365-2796.2004.01406.xOAI: diva2:22388
Available from: 2006-09-15 Created: 2006-09-15 Last updated: 2009-08-19
In thesis
1. Adult Coeliac Disease in Clinical Practice
Open this publication in new window or tab >>Adult Coeliac Disease in Clinical Practice
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Coeliac disease (CD) is considered to be the result of a complex interplay of intrinsic (genetic) factors and variable extrinsic (environmental) factors. The complex background of CD explains its wide spectrum of clinical manifestations. For a very long time CD was considered more or less a disease of childhood, which was extremely rare in adults. Nowadays we know that CD is one of the most common food intolerance disorders.

An epidemiological study of CD in a geographically defined area of Sweden (Paper1) showed a prevalence of 95.5/ 100 000 inhabitants. Among the associated diseases an especially high incidence of associated thyroid disease, 10.8% was observed.

In a fifteen-year cohort follow up study of all CD-patients residing in the counties of Örebro and Linköping (Paper 2) the total mortality was increased with 38% (SMR 1.38 95% C.I. 0.31-0.83). This was mainly explained by a 48% increased death rate in ischemic heart disease, significant in patients over 65 years (SMR 1.58 95% C.I. 1.00-2.06). However, there was a 47 % lower risk of all malignancies (SIR 0.53 95% C.I. 0.31-0.83).

A cohort of 22 consecutively biopsy-proven adult CD patients (Paper 3), were followed in respect of antibody titres from diagnosis and after 1, 3, 6, and 12 months on a gluten free diet (GFD). All antibody titres fell sharply within one month. Thus excluding a CD diagnosis serologically on a patient who has initiated a GFD by herself is not to recommend.

In another cohort with CD patients (Paper IV) who were diagnosed 8-12 years earlier recommended and who were recommended, the reliability of diet history, serological and biochemical markers to predict the appearance of the small intestinal mucosa were analysed (Paper IV). The history of a strict GFD gave a predictive value of 88% of a mucosa in remission. The values of serological tests (AGA, EmA and tTG) to predict a mucosa in remission were 93% for all.

In CD patients in remission gastro-intestinal symptoms were evaluated with the GSRS questionnaire. Subjects with CD reported significantly more GI-symptoms than a general population sample (p<0.01). This was particularly true for women with CD who scored worse than female controls .By contrast men with CD reported no more symptoms than male controls.

Place, publisher, year, edition, pages
Institutionen för molekylär och klinisk medicin, 2006
Linköping University Medical Dissertations, ISSN 0345-0082 ; 954
Coeliaci, prevalence, anocicted deseases, serology symptoms, mortality, malignant diseases
National Category
Clinical Science
urn:nbn:se:liu:diva-7373 (URN)91-85497-93-2 (ISBN)
Public defence
2006-09-22, Universitetsaulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Available from: 2006-09-15 Created: 2006-09-15 Last updated: 2012-03-22

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Midhagen, GunnarOlcén, PerStröm, Magnus
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Gastroenterology and Hepatology Faculty of Health SciencesDepartment of Endocrinology and Gastroenterology UHL
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