Serologic markers of untreated celiac disease in Libyan children: Antigliadin, antitransglutaminase, antiendomysial, and anticalreticulin antibodies

Background: There are, as yet, no data available about the incidence of celiac disease in Libya. The aim of this study was to test the occurrence of serologic markers in a group of Libyan children with positive clinical and histologic findings indicative of celiac disease diagnosis. Methods: Thirty-nine children with untreated celiac disease and 50 healthy school children, all younger than 14 years, were included in the study. Enzyme-linked immunosorbent assay for immunoglobulin G and immunoglobulin A (IgA) antigliadin, antitissue transglutaminase, and anticalreticulin antibodies was used to evaluate the serologic markers of the celiac patients. Immunoglobulin A antiendomysial antibodies were detected by indirect immunofluorescence using human umbilical cord tissue. Results: Clinical symptoms at presentation were weight loss (82%), abdominal distension (61.5%), diarrhea or steatorrhea (59%), pallor (41%), abdominal pain (20.5%), constipation (15%), vomiting (10%), and short stature (7.7%). Most of these symptoms disappeared after introduction of a gluten-free diet. Of 39 patients, only 23 (59%) were endomysium positive and positive also in all other serologic markers. The second group of patients with positive clinical and biopsy findings but anti-endomysial antibody-negative findings was subdivided into two subgroups according to the I-A antigliadin antibody results. Individuals in the I-A gliadin-negative subgroup also lacked I-A autoantibodies. Conclusions: The authors' findings stress the importance of serologic testing not only for screening but also for confirmation of celiac disease.