Speeding up coeliac disease diagnosis in the developing countries

• Published in: Digestive and liver disease 2007-10, Vol.39 (10), p.900-902
• Main Authors: Crovella, S, Brandao, L, Guimaraes, R, de Lima Filho, J.L, Arraes, L.C, Ventura, A, Not, T
• Format: Article
• Language: English
• Subjects: Adult; Anti-transglutaminase antibodies rapid assays; Antibodies - analysis; Biopsy; Brazil - epidemiology; Celiac Disease - diagnosis; Celiac Disease - epidemiology; Celiac Disease - immunology; Coeliac disease; Developing Countries; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Female; Gastroenterology and Hepatology; Humans; Incidence; Male; Mass Screening - methods; Retrospective Studies; Rural Population; Transglutaminases - immunology; Urban Population
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2007.04.016

Abstract Background Anti-transglutaminase antibodies are highly predictive markers of active coeliac disease. Because limited facilities are available for routine use of anti-transglutaminase antibodies assays in developing countries, a simple, economical immunological test would represent a great step forward in the screening of coeliac disease. Aim We determined the prevalence of coeliac disease in two different populations living in an urban area and in a sub-urban impoverished area of Recife (Brazil), using two rapid tests based on detection of anti-transglutaminase antibodies in serum and in one drop of whole blood. Methods Whole-blood and serum samples from 1074 individuals were analysed by the two rapid tests; 580 subjects were university students and 494 subjects were coming from sub-urban impoverished areas, characterized by the endemic presence of filariasis. The positive subjects were evaluated by anti-tranglutaminase enzyme linked immunosorbent assay (ELISA) assay, the coeliac disease-related HLA DQ2/8 and intestinal biopsy. Results Both rapid assays were positive in 25/1074 subjects, but only 9/25 (4/4 in urban areas, specificity 100%; 5/21 in poor areas, specificity 76%) were confirmed positive by ELISA assay. The nine subjects testing positive for HLA DQ2 and the intestinal biopsy showed the typical coeliac disease lesions (coeliac disease-prevalence: 0.84%, 9/1074); seven coeliacs were asymptomatic and two presented recurrent abdominal pain. Conclusions The rapid assays were accurate in finding new coeliacs at a remarkably low cost. We are convinced that this new way of testing for coeliac disease can be successfully used by non-specialized personnel in daily practice in developing countries.