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].

Negative IgA endomysial antibodies make Coeliac Disease highly unlikely if individuals have been on a diet containing adequate gluten (e.g. 4 slices of bread daily) for 6 weeks prior to the test. False negative result may be observed if dietary gluten has been avoided prior to testing.

False negative IgA endomysial antibodies may be observed in patients with IgA deficiency (IgA level <0.08g/L)

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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 5 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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