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p² Background ² Literature data have shown high specificity of

antiendomysial antibodies (EmA IgA) in celiac disease. The scarcity of Brazilian
reports concerning this subject motivated the present study. Objectives - To
determine the sensitivity and specificity of antiendomysial IgA antibodies in Brazilian
celiac patients at diagnosis and after treatment, to confirm patient adherence to a
gluten-free diet and to screen first-degree relatives. Methods - An extensive clinical
and serological study was performed by investigating the presence of these
antibodies in 392 individuals from Southern Brazil. Indirect immunofluorescence
using human umbilical cord as substrate was employed and the total levels of IgA
were determined by turbidimetry in all groups. The study was conducted on 57 celiac
patients (18 at diagnosis, 24 who adhered to a gluten-free diet and 15 with marked
or slight transgression of the diet), 115 relatives of celiac patients (39 families), 94
patients with other gastrointestinal diseases, and 126 healthy individuals from the
general population. Results - The results demonstrated 100% positivity for the
recently diagnosed patients and for those consuming gluten, in contrast to the
patients who complied with the diet (0%). In the control group one individual was
positive, but refused to undergo a biopsy. In the group of other gastrointestinal
diseases, one positive patient presented ulcerative colitis, Down's syndrome and
epilepsy, and the intestinal biopsy was diagnostic for celiac disease. These data
showed 99.3% specificity for the test. Eighteen relatives were positive for
antiendomysial antibodies IgA (15.65%), and comparison with the healthy
population revealed a significant difference. An intestinal biopsy was obtained from
seven subjects (one with total villous atrophy and six withouth alterations in the
mucosal architecture, but all with a high number of intra-epithelial lymphocytes).
Conclusions - The method revealed 100% sensitivity and 99.3% specificity. Because
it is not an invasive method it can be used for the screening of atypical and latent
forms of celiac disease to avoid serial biopsies and to control adherence to a gluten-
free diet with implications in the prevention of malignancy in celiac disease.c

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² Celiac disease, diagnosis. Autoantibodies, analysis. Fluorescent

antibody technique.c

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otze LM da S, Utiyama SR da R, Nisihara RM, Zeni MËB, Sena MÎ de, Amarante

HMS. Anticorpos antiendomísio em pacientes brasileiros com doença celíaca e em
seus familiares de primeiro grau. Arq Îastroenterol 2001;38(2):94-103.c



 ² Racional ² Dados de literatura têm mostrado alta especificidade dos
anticorpos antiendomísio da classe IgA (EmA IgA) na doença celíaca. O pequeno
número de trabalhos brasileiros motivaram o presente estudo. Objetivos -
Determinar a sensibilidade e especificidade dos anticorpos antiendomísio da classe
IgA em celíacos brasileiros ao diagnóstico, após tratamento para confirmar a
aderência à dieta isenta de glúten e como rastreatmento em familiares de primeiro
grau. Métodos - Estudo clínico e sorológico abrangente foi realizado investigando-se
a presença destes anticorpos em 392 indivíduos da região sul do Brasil. Empregou-se
imunofluorescência indireta, tendo como substrato cordão umbilical humano, e os
níveis de IgA sérica foram determinados por turbidimetria, em todos os grupos. O
estudo compreendeu 57 celíacos (18 ao diagnóstico, 24 aderentes à dieta e 15 com
transgressões maiores ou menores), 115 familiares de celíacos (39 famílias), 94
pacientes com outras doenças gastrointestinais e 126 indivíduos sadios da
população. Resultados - Os dados evidenciaram 100% de positividade nos pacientes
recém diagnosticados e nos consumidores de glúten, em contraste com 0% nos
aderentes à dieta. Um indivíduo do grupo controle foi positivo, mas recusou biopsia.
No grupo de outras doenças gastrointestinais, um paciente positivo, portador de
retocolite ulcerativa, também apresentava síndrome de Down, epilepsia e a biopsia
intestinal diagnosticou doença celíaca. Tais dados mostram 99.3% de especificidade.
Dezoito familiares foram positivos para anticorpos antiendomísio da classe IgA
(15.65%) e a correlação com a população sadia foi estatisticamente significativa. Em
sete foi realizada biopsia que demonstrou atrofia total de vilosidades em um e seis
com arquitetura preservada, porém com número elevado de linfócitos intra-epiteliais.
Conclusões - O método revelou 100% de sensibilidade e 99.3% de especificidade.
Ëor não ser invasivo, pode ser usado para rastreamento de formas atípicas ou
latentes de doença celíaca, evita biopsias seriadas e serve para controle da aderência
à dieta, com implicações na prevenção de malignidade na doença celíaca.c



² Doença celíaca, diagnóstico. Auto-anticorpos, análise.

Imunofluorescência.c

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