tTGA: Is it more essential in diagnosis of gluten sensitive enteropathy?
CD is a highly prevalent disease (1:100 to 1:300) which fulfils most of the criteria favoring mass screening. Despite this, screening for gluten sensitive enteropathy (GSE) is still controversial due to its dubious benefits and the acceptance of a gluten-free diet (GFD).
A research article to be published on March 21, 2009 in the World Journal of Gastroenterology address this question. The study shows that GSE patients in the general population may not be identified by clinical features, since a similar percentage of related CD symptoms was found in individuals with positive and negative markers. This fact explains why CD remains underdiagnosed in a high proportion of affected subjects and is an additional argument for mass-screening using other approaches. It was also demonstarted that Marsh I subjects detected by t-TGA evaluation in a non-at-risk group for CD, were as symptomathic as Marsh III patients and also responded to GFD, reinforcing the final diagnosis of GSE in mild enteropathy.
GSE in the general population is frequent and is clinically relevant, irrespective of the severity of the histological lesions. Mass screening programs are useful to identify these patients in order to initiate either a GFD or close follow-up monitoring. t-TG antibody is more sensitive than EmA for the diagnosis of the whole spectrum of GSE in the general population.
The authors of the paper work in a tertiary hospital and individuals were recruited from an Occupational Health Department.
More information: Mariné M, Fernández-Bañares F, Alsina M, Farré C, Cortijo M, Santaolalla R, Salas A, Tomàs M, Abugattas E, Loras C, Ordás I, Viver JM, Esteve M. Impact of mass screening for gluten-sensitive enteropathy in working population. World J Gastroenterol 2009; 15(11): 1331-1338 www.wjgnet.com/1007-9327/15/1331.asp
Source: World Journal of Gastroenterology