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Today, with serological testing (determination of coeliac disease-specific antibodies in the blood) and duodenal biopsy with histological testing being available for diagnosing coeliac disease, patients with suspected coeliac disease are strongly advised to undergo both serological and biopsy testing before undertaking a gluten-free diet. [7]
This antibody is a recommended testing protocol in a proposed revision of the Codex Alimentarius. The new standards came about in part because of new sensitive and specific testing procedures. [14] These procedures are capable of detecting wheat or multiple cereals at concentrations as low as 1 part per million (PPM or 1 mg/kg).
Most attention to anti-transglutaminase antibodies is given with respect to celiac disease. A recent study of children published in 2007 demonstrated that the level of ATA in correlates with the scalar Marsh score for the disease in the same patient. [9] High levels of ATA are found in almost all instances of celiac disease. [10]
Diagnosis is typically made by a combination of blood antibody tests and intestinal biopsies, helped by specific genetic testing. [10] Making the diagnosis is not always straightforward. [22] About 10% of the time, the autoantibodies in the blood are negative, [23] [24] and many people have only minor intestinal changes with normal villi. [25]
The deamidation of glutamine residues catalyzed by tTG is thought to be linked to the pathological immune response to gluten in celiac disease. [12] A schematic for the crosslinking and the deamidation reactions is provided in Figure 1. Figure 1: Transamidation (crosslinking) and deamidation mechanisms of tissue transglutaminase
Persons suspected of having celiac disease may undergo serological testing for IgA anti-tissue transglutaminase antibodies (abbreviated anti-tTG antibodies or anti-TG2 antibodies) and anti-endomysial antibodies (abbreviated EMA) provided the IgA-level is high, and if IgA is low, testing for certain IgG antibodies; in case of positive ...
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