Lesser Degrees of Villous Atrophy Correspond to a Greater Frequency of Seronegative Celiac Disease

Celiac.com 05/08/2007 - A recent study published in the journal Digestive Diseases and Sciences indicates that lesser degrees of villous atrophy correspond to seronegative celiac disease.

The study was conducted by researchers J.A. Abrams, B. Diamond, H. Rotterdam, and P.H. Green, of the Department of Medicine, Columbia University College of Physicians and Surgeons in New York City. The research team set out to assess the effectiveness of various serologic tests used to diagnose celiac disease in patients with differing degrees of villous atrophy. The team evaluated 115 adult patients with biopsy-proven celiac disease. All participants met strict criteria, including serologic testing at the time of diagnosis and response to a gluten-free diet,

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71% of participants showed total villous atrophy and 29% showed partial villous atrophy. Of those with total villous atrophy, 77% tested positive for endomysial antibody, compared to 33% with partial villous atrophy (P < 0.001). No difference in sensitivity was found between those who classical presentation of celiac disease versus those with silent presentation.

Also, patients who were endomysial positive and patients who were endomysial negative showed no difference with respect to age at diagnosis, duration of symptoms, mode of presentation, or family history of celiac disease. Endomysial antibody positivity correlated not with the mode of presentation of celiac disease, but rather, with more severe villous atrophy.

Lastly, the study showed that, in clinical practice, serologic tests lack the sensitivity reported in the literature.

Digestive Diseases and Sciences, 2004 Apr; 49(4):546-50.