Summary:
Celiac disease, a multifactorial autoimmune disorder, which has usually an
atypical clinical presentation in adults, demads the lifelong observance of a
gluten free diet (GFD) as the only treatment. The aim of the present thesis was
the study of specific antibodies, anti- endomysium (EmA), anti-tissue
transglutaminase (tTG-A) and anti-gliadin (AGA), in the diagnosis, monitoring
as well as the prognosis of celiac disease in Greek adult patients. Material
and Methods: The study included: 1) 113 patients with celiac disease, separated
in group A with 70 newly diagnosed patients and group B with 43 patients
already on a GFD. The monitoring of the patients took place for group A on the
moment of the diagnosis and consequently after 6, 12, 24 and 36 months, while
for group B once every year for three years 2) 47 individuals who were first
degree relatives with the patients with celiac disease and 3) 70 individuals
(30 patients with inflammatory and non-inflammatory disease of the intestine
and 40 healthy blood donors) who constituted the comparison group. The
antibodies studied were: a) EmA with indirect immunofluorescence, b) AGA (IgA
and IgG) and tTG-A with ELISA. Furthermore, a quality determination took place
of the immunoglobulins IgG, IgA and IgM and the subclasses of IgG with
nephelometry, of the levels of haemoblogin (Hb) and calcium (Ca) as well the
erythrocyte sedimentation rate (ESR). Results: In group A it was found that a)
EmA had the highest sensitivity, specificity, positive and negative predictive
value in the diagnosis of celiac disease. Furthermore, their descriminant
ability was considerably higher in comparison to the one of AGA-A, AGA-G and
tTG-A, b) all antibodies decreased in quality and quantity with time, in
particular to those who observed a strict diet (statistically a considerable
difference was observed, however, even from the first semester only in EmA,
while in the first , second and third year all antibodies studied had a
predictive capacity for the observance of GFD) d) a considerable decrease in
the percentage of the patients with haemoglobin pathologic values was recorded
over time, e) as much in the measurements of calcium as in the values of ESR no
considerable changes were found in time. For group B there was no considerable
change in time either of the patients’ antibodies and the respective
percentages regardless of the compliance with GFD, or of the other parametres
studied. Finally it was found that 4,2% of the first degree relatives of the
patients with celiac disease were positive for EmA. Conclusions: EmA and tTG-A,
are the optimum markers in the diagnostic approach of celiac disease but also
in the monitoring of GFD compliance. Their application however depends, to a
great deal, from the capacity and the specialization of each laboratory
Keywords:
Celiac disease, Adults, Autoantibodies, Anti-endomysiun, Anti-tissue transglutaminase
