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- Title
Cost-effective strategy for the serological investigation of coeliac disease.
- Authors
Bowron, A.; Moorghen, M.; Morgan, J. E.; Osborne, J. R.; Stansbie, D.; Stone, J. E.
- Abstract
Increased numbers of requests for serological investigation of coeliac disease, and a local trend to request both anti-gliadin antibodies (AGA) and antiendomysium antibodies (AEA) simultaneously, resulted in cost pressures that prompted a review of our practice. Serology results from all patients (771 children, 511 adults) investigated for coeliac disease over a 3-year period were compared with small intestine histology where available. IgG AGA and IgA AGA were measured by enzyme-linked immunosorbent assay (in-house), IgA AEA by immunofluorescence (send-away contract). Overall diagnostic performance was as follows: AGA sensitivity 84% , specificity 88%, positive predictive value (PPV) 24% , negative predictive value (NPV) 99% ; AEA sensitivity 88% , specificity 97% , PPV 65%, NPV 99%. Results showed AGA, with its high NPV, to be a suitable first-line test to exclude coeliac disease. The high specificity of AEA makes it a suitable confirmatory test when AGA is positive. Introduction of this step-wise approach to coeliac disease investigation resulted in cost savings of at least £5000 per year without detriment to the clinical service.
- Subjects
CELIAC disease; DIARRHEA; DIGESTIVE system diseases; MALABSORPTION syndromes; IMMUNOGLOBULINS; IMMUNOFLUORESCENCE
- Publication
Annals of Clinical Biochemistry, 2000, Vol 37, Issue 4, p467
- ISSN
0004-5632
- Publication type
Article
- DOI
10.1258/0004563001899654