Chapter 127 : Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease

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The diagnostic usefulness of serological testing for celiac disease (CD) is well established since the antigens and the immune response involved in its pathogenesis are now known. Serological tests for inflammatory bowel diseases (IBDs) (Crohn’s disease and ulcerative colitis [UC]) have been relatively recently developed, and although clinical use is growing, controversy about their role in diagnosis and management continues. CD is now recognized to be one of the most common inherited diseases in humans, and serological testing has become an indispensable tool for detecting it. Individuals with CD make an immune response directed at a combinatorial antigen involving gliadin (the ethanol-soluble protein of gluten) and tissue transglutaminase (tTG), a ubiquitous enzyme which uses gliadin as a source of glutamine residues that it adds to tissue proteins. Antigliadin antibody (AGA) was the first serological test used to detect CD and to monitor patient compliance with a gluten-free diet. Enzyme immunoassay (EIA) is the method most commonly used to measure AGA. Inflammation in Crohn’s disease is segmental, with affected areas alternating with normal areas in the small intestine. Treatment of Crohn’s disease was formerly limited to anti-inflammatory drugs, rest, and good supportive care. Within the past few years, a new approach to therapy has proven very successful in patients with predominantly small intestinal involvement. Monoclonal antibodies to tumor necrosis factor alpha (TNF-α), a cytokine critical in the inflammatory pathways in Crohn’s disease, or TNF-α receptor analogues are able to block TNF-α activity and dramatically reduce inflammation and clinical symptoms.

Citation: Goeken J. 2006. Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease, p 1125-1131. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch127
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Image of FIGURE 1

Characteristic staining pattern of IgA AEMA on monkey esophagus section as revealed by IIFM.

Citation: Goeken J. 2006. Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease, p 1125-1131. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch127
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Image of FIGURE 2

Staining pattern of atypical P-ANCA associated with IBD on ethanol-fixed human neutrophils as revealed by IIFM. Contrast with typical P-ANCA in Fig. 2 , chapter 118, this volume ( ).

Citation: Goeken J. 2006. Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease, p 1125-1131. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch127
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Sensitivity and specificity of serological tests for CD

Citation: Goeken J. 2006. Immunologic Testing for Celiac Disease and Inflammatory Bowel Disease, p 1125-1131. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch127

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