Serological markers for coeliac disease

UNLABELLED: Antigliadin antibodies (AGA) may be present in healthy adults. One previous study has reported that IgA-AGA detected by population screening may become negative after a 6-year follow-up period. OBJECTIVES: To determine the variability of coeliac disease-associated antibodies with time and to ascertain which antibodies are predictive of the presence of enteropathy. DESIGN: A clinical follow-up study of subjects with positive serological markers detected by screening at the time of the Belfast MONICA Project. METHODS: Jejunal biopsies were carried out endoscopically by means of a Crosby capsule. IgA-antigliadin was detected by a commercial ELISA; IgA-antiendomysial and antireticulin antibodies were determined by indirect immunofluorescence. RESULTS: Of 48 subjects followed up after 4 years, 28 (58%) had developed negative serology and 20 (42%) had persistently positive serology. Thirteen of 20 subjects with persistent serology had villous atrophy. Of 68 subjects followed up after 13 years, 32 (47%) had developed negative serology and 36 (53%) had persistent serology. Of 10 subjects with persistent serology who were biopsied, four had villous atrophy. None of the subjects who developed negative serology were found to have coeliac disease. CONCLUSIONS: Persistence of serological markers as a follow-up to a population screening programme may predict enteropathy in some subjects, whereas subjects who develop negative serology may be reassured. Subjects with persistent serology and normal histology require follow-up to determine if these markers are indicative of latent coeliac disease.