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2. The role of antitissue transglutaminase assay for the diagnosis and monitoring of coeliac disease: A French-Italian multicentre study

Author

Tonutti E., Visentini D., Bizzaro N., Caradonna M., Cerni L., Villalta D., Tozzoli R. F Ferrara, M Barraco, E Migali, D Mariotti, G Danzi, ML Martino, M Danzi, M Baldassarre, G Di Bitonto, M Ciccarelli, D Riello, G Bertiato, G Pedicini, RC Bocchino, F Moccia, G Alessio, P Amboni, C Ottomano, U Volta, A Granito, N Carabellese, R Amato, G Aurnia, C Spagnulo, P Clemen, F Coppola, G Spagnoletti, M Spina, T Trigilia, F Branciforte, L Giancotti, M Apollini, B Malamisura, A Sofia, M Boffardi, F Antico, P Arigliano, G Marcer, E Sala, ML Grassi, G Giana, C Staffa, V Cova, M Martinelli, A Calabrò, D Renzi, D Nigro, D Macchia, M Manfredi, E Cammelli, G Castellucci, L Ferraro, L Marchetti, G Garelli, M Colombo, E Castellano, M Cingolani, A Sabatino, A Di Blasi, M Golato, A Carlucci, G Spagnuolo, G Trivisonno, V Castelli, S Babbini, V Marrè, G Meli, S Amoroso, M Montesanti, E Mei, S Armelloni, C Gerosa, C Marcellino, C Gallo, R Pozzoli, M Peracchi, MT Bardella, C Trovato, VS Arosio, R Malberti, F Rea, MR Di Domenico, A Sergio, P Iardino, V Formicola, G Tamburro, A Massari, M Cirella, E Rondinella, A Pignero, D Scognamiglio, S Spagnuolo, S Orefice, V Romano, B Pennucci, A Maglione, S Lavecchia, A Rubino, O Leone, N Cantieri, F Michelutti, G Guariso, D Basso, S Teresi, E Gucciardino, M Di Gregorio, MA Trippiedi, P Greco, R Guadagna, E Maltese, T Imbastaro, G Lombardi, A Rossi, E Savi, L Spada, D Villalta, G Tabellini, M Saccarola, P Palumbo, G Marinucci, PM Strappini, F Viola, M Barbato, Roma, N Bizzaro, P Pasini, F Minetti, M Scogna, M Vascotto, G Morgese, F Bascietto, P Cantelmi, F Bulacanti, D Bassetti, S Santer, D Prizzon, S Loperfido, S Martelossi, T Not, A Ventura, E Tonutti, D Visentini, S Finazzi, S Salvatore, GV Melzi d’Eril, D Wolf, M Montesanto, M Negri, MG Azzeni, R Giordano, M Farina, S Micieli, V Gouilleux, O Bandin, A Tridon, M Meyer, F Bienvenu, G Beaune, S Jego, M San Marco, D Bernard, J Sarles, J Sahel, D Carre, S Benzaken, JF Demarquay, C Johanet, JJ Baudon., Tonutti E., Visentini D., Bizzaro N., Caradonna M., Cerni L., Villalta D., Tozzoli R. F Ferrara, M Barraco, E Migali, D Mariotti, G Danzi, ML Martino, M Danzi, M Baldassarre, G Di Bitonto, M Ciccarelli, D Riello, G Bertiato, G Pedicini, RC Bocchino, F Moccia, G Alessio, P Amboni, C Ottomano, U Volta, A Granito, N Carabellese, R Amato, G Aurnia, C Spagnulo, P Clemen, F Coppola, G Spagnoletti, M Spina, T Trigilia, F Branciforte, L Giancotti, M Apollini, B Malamisura, A Sofia, M Boffardi, F Antico, P Arigliano, G Marcer, E Sala, ML Grassi, G Giana, C Staffa, V Cova, M Martinelli, A Calabrò, D Renzi, D Nigro, D Macchia, M Manfredi, E Cammelli, G Castellucci, L Ferraro, L Marchetti, G Garelli, M Colombo, E Castellano, M Cingolani, A Sabatino, A Di Blasi, M Golato, A Carlucci, G Spagnuolo, G Trivisonno, V Castelli, S Babbini, V Marrè, G Meli, S Amoroso, M Montesanti, E Mei, S Armelloni, C Gerosa, C Marcellino, C Gallo, R Pozzoli, M Peracchi, MT Bardella, C Trovato, VS Arosio, R Malberti, F Rea, MR Di Domenico, A Sergio, P Iardino, V Formicola, G Tamburro, A Massari, M Cirella, E Rondinella, A Pignero, D Scognamiglio, S Spagnuolo, S Orefice, V Romano, B Pennucci, A Maglione, S Lavecchia, A Rubino, O Leone, N Cantieri, F Michelutti, G Guariso, D Basso, S Teresi, E Gucciardino, M Di Gregorio, MA Trippiedi, P Greco, R Guadagna, E Maltese, T Imbastaro, G Lombardi, A Rossi, E Savi, L Spada, D Villalta, G Tabellini, M Saccarola, P Palumbo, G Marinucci, PM Strappini, F Viola, M Barbato, Roma, and N Bizzaro, P Pasini, F Minetti, M Scogna, M Vascotto, G Morgese, F Bascietto, P Cantelmi, F Bulacanti, D Bassetti, S Santer, D Prizzon, S Loperfido, S Martelossi, T Not, A Ventura, E Tonutti, D Visentini, S Finazzi, S Salvatore, GV Melzi d’Eril, D Wolf, M Montesanto, M Negri, MG Azzeni, R Giordano, M Farina, S Micieli, V Gouilleux, O Bandin, A Tridon, M Meyer, F Bienvenu, G Beaune, S Jego, M San Marco, D Bernard, J Sarles, J Sahel, D Carre, S Benzaken, JF Demarquay, C Johanet, JJ Baudon.

Subjects
Immunoglobulin A, Adult, Male, Adolescent, Tissue transglutaminase, Reproducibility of Result, Enzyme-Linked Immunosorbent Assay, Autoantigens, Sensitivity and Specificity, Coeliac disease, Pathology and Forensic Medicine, Serology, Antigen, Autoantigen, Immunopathology, Humans, Medicine, Age Factor, Child, Autoantibodies, Transglutaminases, biology, business.industry, Age Factors, Reproducibility of Results, Infant, Original Articles, General Medicine, Biomarker, medicine.disease, Autoantibodie, Celiac Disease, Child, Preschool, Immunoglobulin G, Immunology, biology.protein, Gluten free, Female, Antibody, business, Biomarkers, Human
Abstract

Aims: Tissue transglutaminase (tTG) was recently identified as the major autoantigen in coeliac disease. The aim of this multicentre study was to evaluate the impact of a new immunoenzymatic assay for the detection of IgA anti-tGT antibodies. Methods: Seventy four Italian and French clinical laboratories participated in this study; anti-tTG IgA with an enzyme linked immunosorbent assay (ELISA) method using guinea pig liver extract as the coating antigen, anti-endomysium IgA autoantibodies (EMA), and total serum IgA were determined in 7948 patients, 1162 of whom had coeliac disease (737 untreated cases and 425 on a gluten free diet). A proportion of the sera were then sent to a reference laboratory for anti-tTG retesting with an ELISA method using recombinant human tTG antigen. Results: Seven thousand four hundred and fifty eight (93.8%) sera were EMA/antiguinea pig tTG concordant (positive or negative); 490 (6.2%) were non-concordant. The sensitivity of EMA and antiguinea pig tTG in the 737 untreated patients with coeliac disease was 92.1% and 94.8%, respectively, and the specificity was 99.8% and 99.2%, respectively. Retesting of the discordant sera showed that of the 162 sera classified as EMA negative/antiguinea pig tTG positive, only 49 were positive for human recombinant anti-tTG, and that 39 of these were also EMA positive. Furthermore, of the 36 sera classified as EMA positive/antiguinea pig tTG negative, only two were confirmed as EMA positive. Conclusions: The antiguinea pig tTG assay is more sensitive but less specific than EMA, whereas the antihuman recombinant tTG assay is far more specific and just as sensitive as antiguinea pig tTG. Testing for EMA presents considerable interpretative problems and is difficult to standardise.

Published
2003

3. Coeliac disease in primary care: Evaluation of a case-finding strategy.

Author

Berti, I., Della Vedova, R., Paduano, R., Devetta, M., Caradonna, M., Villanacci, V., Not, T., Martelossi, S., Tamburlini, G., and Ventura, A.

Subjects
CELIAC disease, DIARRHEA, PRIMARY care, TRANSGLUTAMINASES
Abstract

Abstract: Background: Coeliac disease is still under-diagnosed as a consequence of poor physician awareness of the clinical spectrum of the disease. We evaluated the feasibility and the cost-effectiveness of a case-finding approach for early identification of cases, carried out by primary care practitioners. Methods: We developed a case-finding strategy based on testing for anti-tissue transglutaminase IgA antibodies in subjects showing predefined signs and symptoms or belonging to at-risk groups. Results: Sixty-nine primary care doctors and 60 primary care paediatricians agreed to participate. One thousand forty-one adults and 447 children were selected for anti-tissue transglutaminase testing during the year of the study (2001). Thirty-one (2.08%, 19 adults and 12 children) were ultimately diagnosed as coeliac patients. While no cases of coeliac disease had been diagnosed by the participating doctors in the previous year, 29 subjects were diagnosed as coeliacs in the year after the completion of the study (2002). The prevalence of confirmed coeliac disease in the population under study increased from 1:1506 to 1:1073 in adults and from 1:827 to 1:687 in children from year 2000 to 2001. When cases diagnosed in 2002 are included, the prevalence is 1:832 and 1:602, respectively. We calculated a cost of 923.25 euros for each new case diagnosed. Conclusions: Case-finding is a feasible and successful strategy for detecting undiagnosed coeliac patients and has the important added value of increasing the awareness of the disease among primary care physicians; it represents a cost-effective alternative to population screening for reducing the burden of undiagnosed coeliac disease. [Copyright &y& Elsevier]

Published
2006
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4. Coeliac disease in primary care: Evaluation of a case-finding strategy

Author

Stefano Martelossi, Giorgio Tamburlini, R. Della Vedova, Irene Berti, Romano Paduano, Alessandro Ventura, M. Devetta, Vincenzo Villanacci, Maurizio Caradonna, Tarcisio Not, Berti, I, DELLA VEDOVA, R, Paduano, R, Devetta, M, Caradonna, M, Villanacci, V, Not, Tarcisio, Martelossi, S, Tamburlini, G, and Ventura, Alessandro

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Adolescent, Population, Primary health care, Signs and symptoms, Disease, Primary care, Coeliac disease, GTP-Binding Proteins, Risk Factors, medicine, Humans, Protein Glutamine gamma Glutamyltransferase 2, Child, education, Aged, education.field_of_study, Transglutaminases, Primary Health Care, Hepatology, business.industry, Gastroenterology, Infant, Middle Aged, medicine.disease, Immunoglobulin A, Celiac Disease, Child, Preschool, Case finding, Female, Immunotherapy, Population screening, business
Abstract

Background Coeliac disease is still under-diagnosed as a consequence of poor physician awareness of the clinical spectrum of the disease. We evaluated the feasibility and the cost-effectiveness of a case-finding approach for early identification of cases, carried out by primary care practitioners. Methods We developed a case-finding strategy based on testing for anti-tissue transglutaminase IgA antibodies in subjects showing predefined signs and symptoms or belonging to at-risk groups. Results Sixty-nine primary care doctors and 60 primary care paediatricians agreed to participate. One thousand forty-one adults and 447 children were selected for anti-tissue transglutaminase testing during the year of the study (2001). Thirty-one (2.08%, 19 adults and 12 children) were ultimately diagnosed as coeliac patients. While no cases of coeliac disease had been diagnosed by the participating doctors in the previous year, 29 subjects were diagnosed as coeliacs in the year after the completion of the study (2002). The prevalence of confirmed coeliac disease in the population under study increased from 1:1506 to 1:1073 in adults and from 1:827 to 1:687 in children from year 2000 to 2001. When cases diagnosed in 2002 are included, the prevalence is 1:832 and 1:602, respectively. We calculated a cost of 923.25 euros for each new case diagnosed. Conclusions Case-finding is a feasible and successful strategy for detecting undiagnosed coeliac patients and has the important added value of increasing the awareness of the disease among primary care physicians; it represents a cost-effective alternative to population screening for reducing the burden of undiagnosed coeliac disease.

Published
2006
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