To screen or not to screen? Celiac antibodies in liver diseases

Table 3 Research on screening celiac disease in patients with primary biliar cholangitis

Study	Screening method	Number of positive patients	Typical duodenal biopsy12	Response to gluten-free diet	Country, year	Ref.
Prospective	Duodenal biopsy	5/26 (19.2%)	19, 2%	No improvement in liver biochemestry	Sweden, 1982	Olsson et al[61]
Retrospective	Previous diagnose	2/18 (11.1%)	Not mentioned	No improvement in liver biochemestry or liver histology	Sweden, 1985	Löfgren et al[65]
Prospective	EmA IFI > 1:5	6/57 (11%) EmA (+)	7%	No improvement in liver biochemestry	Ireland, 1997	Dickey et al[73]
Prospective cohort	AGA IgG IgA > 1 AU	0/62 (0%) EmA (+)	0/0	-	United States/Italy	Volta et al[76]
	IgA EmA IFI	11/62 (16%) AGA (+)
Prospective	malabsorption, haematinic	4/67 (6%)	4/67 (6%)	No improvement in liver biochemestry	United Kingdom, 1998	Kingham et al[72]
	deficiency, positive antigliadin antibody,
	or CD family history
Prospective	AGA IgA > 25 AU/mL	4/11 (36, 4%) AGA IgA (+)	18%	-	Argentina, 1998	Niveloni et al[102]
	IgG > 28 AU/mL	1/11 (9%) AGA IgG (+)
	EmA IFI > 1:5	1/11 (9%) EmA (+)
Retrospective (stored sera)	EmA IFI > 1:5	10/378 (2.6%) EmA (+) + tTG (+)	1.30%	-	United Kingdom, 2000	Gillett et al[103]
	tTG IgA ELISA > 140 AU/mL	44/378 (11.6%) EmA (-) + tTG (+)
Prospective	EmA IFI	3/87 (3.4%) EmA (+)	0/17	-	Italy, 2002	Floreani et al[80]
	tTG IgA > 10 IU	24/87 (27.5%) tTG (+)
Prospective	AGA IgA > 50 U/mL	13/62 (21%) AGA (+)	0/10	-	Greece, 2002	Chatzicostas et al[78]
	AGA IgG > 50 U/mL	0/62 EmA (+)
	EmA IgA IFI ≥ 1:5	6/62 (10%) tTG (+)
	IgA tTG > 30 U/mL
Prospective cohort	EmA IFI > 1:5	7/173 (4%) EmA (+)	7/7	No improvement in liver biochemestry	Italy/Spain 2002.	Volta et al[52]
	tTG IgA > 7 AU	5/173 (2.9%) tTG (+)
	AGA IFI
Prospective cohort	IgA tTG > 7 AU	5/48 (10.4%) tTG (+)	-	-	Italy, 2003	Bizzaro et al[104]
	IgG anti-Ttg > 30 AU
	EmA IFI
	tTG < 1:100	7/115 (6.1%) tTG (+)	1/8	Duodenal histological improvement	Poland, 2003	Habior et al[105]
	EmA IFI	1/115 (0.9%) EmA (+)
	AGA Elisa	8/115 (7.0%) AGA (+)
Prospective cohort	Six different ELISA tTG	28/105 (26.7%) tTG IgA (+)	100% EmA (+)	-	Italy, 2006	Bizzaro et al[25]
		6/105 (5.7%) tTG IgG (+)	0% tTG (+)

¹Vilous atrophy, crypt hyperplasia, lymphoplasmocytic infiltrate;

²Only a small number of patients usually undergo intestinal biopsy. EmA: Anti-endomysial antibody; IIF: Indirect immunofluorescence; tTG: Anti-tissue transglutaminase; ELISA: Enzyme-linked immunosorbent assay; CD: Celiac disease; AGA: Anti-gliadin antibody.