Endomysial Antibodies (IgA)

Immunology

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Description

IgA endomysial antibodies ( IgA EMA ) react with the reticulin component of smooth muscle endomysium and are indicative of gluten sensitive enteropathy. IgA anti-endomysial is more specific than IgA tissue transglutaminase antibodies but both are reportedly of equal sensitivity [1]. IgA endomysial antibodies are poor predictors of villous recovery [1]. There has been a long standing controversy over the optimal testing strategy for patients with suspected coeliac disease however the NICE guidelines recommend IgA tissue transglutaminase antibodies as a first line test followed by IgA endomysial antibodies if the IgA TGT is equivocal [2]. Patients with positive serology should be referred to gastroenterology for a duodenal biopsy, the current gold standard for the diagnosis of coeliac disease. Seronegative coeliac disease occurs in a small proportion of patients ( 6.4% ) [1]. Patients with a negative serology who continue to have a high clinical suspicion of coeliac disease should be referred to gastroenterology [2].

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Indications

Coeliac Disease, Dermatitis Herpetiformis.

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Sample Type

2mL Serum ( Gel 5mL Yellow tube ). Requests from outside Sheffield: Transport at ambient temperature via Royal Mail or Courier.

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Reference Range

Normal result = Negative.

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Turnaround Time

Within 3 days

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Testing Frequency

Daily

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References

NICE clinical guideline 20 ( NG20 ). Coeliac disease: Recognition, assessment and management. 2015. [Ref 2].
Hopper AD, et al. What is the role of serologic testing in coeliac disease? A prospective, biopsy-confirmed study with economic analysis. Clinical Gastroenterology and Hepatology. 2008. 6:314-320. [Ref 1]
Hopper AD, et al. Pre-endoscopy serological testing for coeliac disease:evaluation of a clinical decision tool. BMJ. 2007. 334:729.
Hopper AD, et al. Adult coeliac disease. BMJ. 2007. 335: 558-562.
Heel DA, West J. Recent advances in coeliac disease. Gut. 2006. 55:1037-1046.
Rostom A, et al. The diagnostic accuracy of serologic tests for coeliac disease: a systematic review. 2005. 128( 4 ):S38-46.

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See Also

Tissue transglutaminase.

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