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Tailored Testing for Celiac Disease

Shadi Rashtak, MD; and Joseph A. Murray, MD
[+] Article, Author, and Disclosure Information

From Mayo Clinic College of Medicine, Rochester, MN 55905.

Grant Support: Dr. Murray is supported in part by National Institutes of Health grants DK071003 and DK 57892 and by the Mayo Foundation.

Potential Financial Conflicts of Interest: Dr. Murray has consulted for, has received honoraria from, and is on the Scientific Advisory Board of Alvine Inc., which is developing treatments for celiac disease. He is also an employee of the Mayo Clinic, which has received a grant as part of a multicenter study from Alba Inc. Alba Inc. is also developing treatments for celiac disease. The topic of this paper, however, does not directly relate to the products being developed or tested by either company.

Requests for Single Reprints: Joseph A. Murray, MD, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905; e-mail, mailto: murray.joseph@mayo.edu.

Current Author Addresses: Drs. Rashtak and Murray: Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905.

Ann Intern Med. 2007;147(5):339-341. doi:10.7326/0003-4819-147-5-200709040-00009
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Celiac disease is a gluten-sensitive enteropathy occurring in genetically susceptible individuals and affecting almost 1% of the population. The small-intestine biopsy, currently the gold standard test, is a rather invasive and expensive test to serve as the initial step in the diagnosis of celiac disease (12). Therefore, current guidelines recommend serologic testing for autoantibodies against tissue transglutaminase (TGA) or endomysium (EMA) as the first step (12). Most studies have reported excellent sensitivity and specificity for these tests (34), but some studies have reported unsatisfactory sensitivity, particularly among patients with mild intestinal damage (56). The HLA types DQ2 or DQ8 are strongly associated with celiac disease, but few researchers have tested this association as a basis for diagnosis (7).

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