Prevalence of IgA-antiendomysial antibody in asymptomatic low bone mineral density

Kieren Mather, Jon B. Meddings, Paul L. Beck, R. Brent Scott, David A. Hanley

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

OBJECTIVE: Celiac disease (CD) is a relatively common gastrointestinal disorder that can be asymptomatic. However, even among asymptomatic patients a long-term reduction in bone mineral density (BMD) is found. Excellent noninvasive screening tests for CD are now available. Studies using older screening techniques have suggested a 10-fold increased prevalence of CD among patients with low BMD, but this has not been confirmed with current testing methodology. We set out to confirm these prevalence estimates using antiendomysial antibody testing. METHODS: A total of 100 consecutive patients referred to our outpatient endocrinology clinic for evaluation of idiopathic low BMD were studied. In addition to the routine evaluation, patients completed a symptom questionnaire and underwent serological testing for the presence of the IgA antiendomysial antibody (EMA). All patients with a positive EMA underwent small bowel biopsy and permeability studies. RESULTS: EMA results were available on 96 patients; 78/96 patients were female and the mean age was 57 yr (range 18-86 yr). Seven of 96 (7.3% [95% CI 2.1-12.5%]) were EMA-positive, but all tests were low titer (≤1:20). However, none of the biopsies showed any histopathological features of CD, nor did EMA status correlate with any of the clinical or laboratory features assessed. CONCLUSIONS: Despite a high rate of weakly positive antibody tests, our data do not support an increased prevalence of CD among asymptomatic patients referred for evaluation of low BMD. Without an increase over the background prevalence, the high cost of EMA testing argues against routine use of this test for screening of this population.

Original languageEnglish (US)
Pages (from-to)120-125
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume96
Issue number1
DOIs
StatePublished - 2001
Externally publishedYes

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Bone Density
Immunoglobulin A
Celiac Disease
Antibodies
Biopsy
Endocrinology
Ambulatory Care Facilities
Permeability
Costs and Cost Analysis
Population

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Prevalence of IgA-antiendomysial antibody in asymptomatic low bone mineral density. / Mather, Kieren; Meddings, Jon B.; Beck, Paul L.; Scott, R. Brent; Hanley, David A.

In: American Journal of Gastroenterology, Vol. 96, No. 1, 2001, p. 120-125.

Research output: Contribution to journalArticle

Mather, Kieren ; Meddings, Jon B. ; Beck, Paul L. ; Scott, R. Brent ; Hanley, David A. / Prevalence of IgA-antiendomysial antibody in asymptomatic low bone mineral density. In: American Journal of Gastroenterology. 2001 ; Vol. 96, No. 1. pp. 120-125.
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abstract = "OBJECTIVE: Celiac disease (CD) is a relatively common gastrointestinal disorder that can be asymptomatic. However, even among asymptomatic patients a long-term reduction in bone mineral density (BMD) is found. Excellent noninvasive screening tests for CD are now available. Studies using older screening techniques have suggested a 10-fold increased prevalence of CD among patients with low BMD, but this has not been confirmed with current testing methodology. We set out to confirm these prevalence estimates using antiendomysial antibody testing. METHODS: A total of 100 consecutive patients referred to our outpatient endocrinology clinic for evaluation of idiopathic low BMD were studied. In addition to the routine evaluation, patients completed a symptom questionnaire and underwent serological testing for the presence of the IgA antiendomysial antibody (EMA). All patients with a positive EMA underwent small bowel biopsy and permeability studies. RESULTS: EMA results were available on 96 patients; 78/96 patients were female and the mean age was 57 yr (range 18-86 yr). Seven of 96 (7.3{\%} [95{\%} CI 2.1-12.5{\%}]) were EMA-positive, but all tests were low titer (≤1:20). However, none of the biopsies showed any histopathological features of CD, nor did EMA status correlate with any of the clinical or laboratory features assessed. CONCLUSIONS: Despite a high rate of weakly positive antibody tests, our data do not support an increased prevalence of CD among asymptomatic patients referred for evaluation of low BMD. Without an increase over the background prevalence, the high cost of EMA testing argues against routine use of this test for screening of this population.",
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